Relocation module and methods for surgical equipment

ABSTRACT

Modules for housing electronic and electromechanical medical equipment including a system to measure and record administration of one or more IV medications or fluids for IV administration.

PRIORITY

This application is a continuation of U.S. application Ser. No.18/099,500, filed Jan. 20, 2023, which is a continuation of U.S.application Ser. No. 17/862,971, filed Jul. 12, 2022 now U.S. Pat. No.11,583,459, which is a continuation of U.S. application Ser. No.17/550,611, filed Dec. 14, 2021, now U.S. Pat. No. 11,426,320, which isa continuation of U.S. application Ser. No. 17/332,523, filed May 27,2021, now U.S. Pat. No. 11,219,569 B2, which is a continuation of U.S.application Ser. No. 17/167,681, filed Feb. 4, 2021, now issued as U.S.Pat. No. 11,160,710, which is a continuation-in-part of U.S. applicationSer. No. 17/092,681, filed Nov. 9, 2020, now issued as U.S. Pat. No.10,993,865 B2, which is a continuation of U.S. application Ser. No.16/879,406, filed May 20, 2020, now issued as U.S. Pat. No. 10,869,800.The disclosure of all of these applications are incorporated herein byreference in their entirety.

TECHNICAL FIELD

This document pertains generally, but not by way of limitation, tosystems and methods that provide a “chain of custody” for medications,from the time of issuance from the pharmacy until the administration tothe patient, to assure the right drug is administered to the rightpatient and to prevent pilferage of scheduled drugs such as narcotics,by the medical staff. This document also pertains generally to systemsand methods for improving safety for patients receiving intravenous (IV)medications and fluids, by avoiding medication or fluid errors anddocumenting the administration.

BACKGROUND

Many medications are given intravenously (IV) to patients all throughoutthe healthcare system, including but not limited to: in the operatingroom (OR), the emergency room (ER), intensive care unit (ICU), the wardand the clinic. Medication security, especially for scheduled drugs suchas narcotics is an ongoing challenge for healthcare systems. Narcotics,for example, can be securely stored, tracked and accounted for in thepharmacy or medication dispensing machine. However, once the drug ischecked out of the pharmacy or medication dispensing machine, there isno further security and whether that specific drug is administered tothe patient as intended or is stolen by the healthcare provider who maybe addicted, is entirely dependent on the integrity of the individualprovider.

In general, at this date there is no way to track or monitor each doseof a narcotic between when it is checked out of the pharmacy ormedication dispensing machine and when it is injected into the patient.In other words, the final link in the “chain of custody” for that drugrelies solely on the personal integrity of the healthcare provideradministering the drug. It is not uncommon for drug addicted healthcareproviders to steal narcotics after checking them out and then load orreload the syringe with any clear fluid such as saline which is theninjected into the patient's IV line.

There is a need for a security system for IV medications that can trackeach dose of medication form the time it is checked out of the pharmacyor medication dispensing machine until it is injected into the patientsIV. In other words, there is a need for an automatic system thatmonitors and documents the final link in the “chain of custody” for thatdrug dose and does not rely on the personal integrity of the healthcareprovider administering the drug.

SUMMARY

In some examples, the security system for IV medications of thisdisclosure provides medication security for scheduled drugs such asnarcotics. The specific syringe or bottle or ampule of the drug may belabeled with and RFID tag, a barcode, QR code marking or othermachine-identifiable label (“barcode” and “QR code” are usedinterchangeably in this disclosure and can include any type of readableimage or code). The specific syringe, bottle, ampule or vial of the drugis identified by the RFID tag or barcode and its identity isautomatically documented when it is checked out of the pharmacy. In someexamples, the healthcare provider may also be positively identified byRFID or barcode identification that may be attached to a healthcareprovider's ID badge, for example. The final link in the “chain ofcustody” for a specific drug dose begins when a provider scans their IDbadge in order to check the specific drug out from the pharmacy ormedication dispensing machine.

In some examples, the security system for IV medications at thepatient's bedside uses the RFID or barcode on the provider's ID badge toidentify the person injecting the medication or administering the fluid.In some examples, the security system for IV medications at thepatient's bedside uses the RFID or barcode on the injection syringe toidentify the specific dose of that drug that was checked out of thepharmacy or medication dispensing machine. Having established theidentity of the person giving the injection and identified the contentsof the injection syringe, the security system for IV medications“watches” the drug being injected into the IV line using machine vision,documenting that the specific drug was given to the patient. When theinjection is complete, the “chain of custody” from the pharmacy to thepatient for that drug dose can be considered complete. This isespecially important for scheduled medications such as narcotics, wherepilferage by the medical staff has been known to occur.

In some examples, tamper-proof, non-refillable syringes may be desirableto assure that the RFID tagged or barcode labeled syringe was notemptied of its drug while enroute to the patient and then reloaded withsaline before injecting into the patient.

The safety and security system for IV medications and fluids can alsomake an automatic electronic record of medication and fluid delivery tothe patient. The electronic record may have many names including but notlimited to the electronic anesthetic record (EAR), the electronicsurgical record (ESR), the electronic medical record (EMR) or theelectronic health record (EHR). In this disclosure we will use“electronic medical record” (EMR) to generally refer to all electronicrecords.

In some examples, the security system for IV medications of thisdisclosure includes a system for automatically measuring and recordingthe administration of IV medications and fluids. The automated EMRrelies on automatic IV medication and fluids data entry. The system forautomatically measuring and recording the administration of IVmedications and fluids can include one or more sensors, such as, butlimited to, one or more of a barcode reader or an RFID interrogator foraccurately identifying a medication or fluid for IV administration.

The system for automatically measuring and recording the administrationof IV medications and fluids can also include, or can instead include,one or more digital cameras with machine vision software (“machinevision”) for accurately measuring the volume of medication administeredfrom a syringe or fluid administered from an IV bag through a dripchamber into an IV tubing. The digital cameras with machine visionsoftware essentially duplicate the clinician's vision of an activity,injection of a drug from a syringe for example, without interfering inthe normal activity and yet allows automatic recording of the activityin the EMR. The machine vision software can include one or moremachine-readable mediums that when implemented on hardware processingcircuitry of the system or in electrical communication with the system,can perform the functions described herein.

Doctors and nurses dislike record keeping and the switch to theelectronic record has made the act of record keeping more difficult andtime consuming. Entering the electronic record into the computersometime after the event occurred, is not only distracting from patientcare but leads to inaccurate records.

In some examples, the automatic EMR of the security system for IVmedications of this disclosure lets the computer (e.g., a processor andmemory for performing instructions) add to patient safety by checkingdrug identities, dosages, side effects, allergies, the patients' medicalhistory and vital signs and alerting the clinician to potential problemsor even physically stopping the drug administration. In some examples,the automatic EMR of this disclosure eliminates medication errors bychecking the drug to be injected against the physician's medicationorders before the injection can occur. In some examples, the automaticEMR of this disclosure is useful for managing drug inventories because agiven medication administration is tied to a specific drug bottle orsyringe. Finally, the computer mouse and keyboards have been shown to becontaminated by a wide variety of infective organisms and are virtuallyimpossible to clean. Automatic data entry to the EMR would improvepatient safety, improve clinician job satisfaction and improvemedication inventory management.

In some examples, the automatic EMR of the security system for IVmedications of this disclosure may also automatically record and displaymany other functions including but not limited to: IV fluidadministration, medication infusions, the patient's vital signs, urineoutput, blood loss, ventilator settings, inspired gases, electrosurgicalsettings, pneumoperitoneum insufflation settings, RFID surgical spongecounts, surgical information and video, dialysis or other medicalprocedure information and patient activity.

In some examples, the automatic EMR of the security system for IVmedications may allow remote viewing of the displayed patientinformation. In some examples, the remotely displayed patientinformation may be used for remote medical supervision such as ananesthesiologist providing remote supervision to a nurse anesthetist whois administering the anesthetic. In some examples, the remotelydisplayed patient information may be used for remote medicalconsultation. In some examples, the remotely displayed patientinformation may be used to document the involvement of remote medicalsupervision or consultation for billing purposes.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numeralsmay describe similar components in different views. Like numerals havingdifferent letter suffixes may represent different instances of similarcomponents. The drawings illustrate generally, by way of example, butnot by way of limitation, various examples discussed in the presentdocument. Any combination of the features shown and described in thisdisclosure, including combinations of fewer or more features is withinthe content of this disclosure. Modules, systems and methods includingindividual features described herein, without combinations of featuresas shown in the examples (for the sake of brevity), are also within thescope of this disclosure.

FIG. 1 illustrates an isometric view of an example module including asystem for generating an automated electronic anesthetic record locatedproximate to a patient, in accordance with at least one example of thisdisclosure.

FIG. 2 illustrates an isometric view of an example module including asystem for generating an automated electronic anesthetic record locatedproximate to a patient, in accordance with at least one example of thisdisclosure.

FIG. 3 illustrates a plan view of an example of preloaded syringes 200Aand 200B that can be used with the system of FIGS. 1 and 2 , inaccordance with at least one example of this disclosure.

FIG. 4 illustrates a side view of an example medication identificationand measurement system and a syringe that can be used with the system ofFIGS. 1 and 2 , to monitor drug delivery, in accordance with at leastone example of this disclosure.

FIG. 5 illustrates a cross-sectional view of the medicationidentification and measurement system and a syringe (not shown incross-section) of FIG. 4 , taken along line 5-5, in accordance with atleast one example of this disclosure.

FIG. 6 illustrates a side view of a second example medicationidentification and measurement system and a syringe that can be usedwith the system of FIGS. 1 and 2 , in accordance with at least oneexample of this disclosure.

FIG. 7 illustrates a cross-sectional view of the second example of amedication identification and measurement system and the syringe (notshown in cross-section) of FIG. 6 , taken along line 7-7, in accordancewith at least one example of this disclosure.

FIG. 8 illustrates a side view of a third example of a medicationidentification and measurement system and a syringe that can be usedwith the system of FIGS. 1 and 2 , in accordance with at least oneexample of this disclosure.

FIG. 9 illustrates a cross-sectional view of the third example of amedication identification and measurement system and the syringe (notshown in cross-section) of FIG. 8 , taken along line 9-9, in accordancewith at least one example of this disclosure.

FIG. 10 illustrates an example injection port cassette that can be usedwith the system of FIGS. 1 and 2 , as detailed in FIGS. 5, 7 and 9 , inaccordance with at least one example of this disclosure.

FIG. 11 illustrates a plan view of an example of healthcare provider IDbadges that can be used with the system of FIGS. 1 and 2 , in accordancewith at least one example of this disclosure.

FIG. 12 illustrates a longitudinal cross-sectional view of an example ofa medication security syringe that can be used with the system of FIGS.1 and 2 , in accordance with at least one example of this disclosure.

FIG. 13 illustrates a longitudinal cross-sectional view of an example ofa medication security syringe that can be used with the system of FIGS.1 and 2 , in accordance with at least one example of this disclosure.

FIG. 14 illustrates a side view of an example IV fluid identificationand measurement system that can be used with the systems of FIGS. 1 and2 , and injection port cassette of FIG. 10 , in accordance with at leastone example of this disclosure.

FIG. 15 illustrates generally an example of a block diagram of a machine(e.g., of module 101, 201) upon which any one or more of the techniques(e.g., methodologies) discussed herein may perform in accordance with atleast one example of this disclosure.

FIG. 16 is a flow chart illustrating a technique of IV fluididentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 17 is a second flow chart illustrating the technique of IV fluididentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 18 is a flow chart illustrating a technique of medicationidentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 19 is a second flow chart illustrating a technique of medicationidentification and measurement, in accordance with at least one exampleof this disclosure.

FIG. 20 is a flow chart illustrating a second technique of IV fluididentification and measurement including safety and security aspects, inaccordance with at least one example of this disclosure.

FIG. 21 is a second flow chart illustrating a second technique of IVfluid identification and measurement including safety and securityaspects, in accordance with at least one example of this disclosure.

FIG. 22 illustrates generally an example of a block diagram of vendingsystem and a medication delivery system of FIGS. 1-21 upon which any oneor more of the techniques (e.g., methodologies) discussed herein mayperform in accordance with at least one example of this disclosure.

FIG. 23 is a flow chart illustrating a technique 2300 for assessingphysiologic events, in accordance with at least one example of thisdisclosure.

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description providespractical illustrations for implementing exemplary examples of thepresent invention. Examples of constructions, materials, dimensions, andmanufacturing processes are provided for selected elements, and allother elements employ that which is known to those of skill in the fieldof the invention. Those skilled in the art will recognize that many ofthe examples provided have suitable alternatives that can be utilized.

As described herein, operably coupled can include, but is not limitedto, any suitable coupling, such as a fluid (e.g., liquid, gas) coupling,an electrical coupling or a mechanical coupling that enables elementsdescribed herein to be coupled to each other and/or to operate togetherwith one another (e.g., function together).

FIG. 1 illustrates an isometric view of an example safety and securitysystem 100 for generating an automated electronic anesthetic record(EAR) or electronic medical record (EMR) located proximate to a patient.Some aspects of FIG. 1 are also described with respect to thedescription of other figures, including FIG. 14 .

As shown in FIG. 1 , the safety and security system for intravenous (IV)medications 100 may be attached to and portions can be stored within amodule 101. The module 101 can conveniently provide direct access to thepatient 102. An IV pole 105 may provide a convenient mounting supportlocation for the safety and security system for IV medications 100(hereinafter, “safety and security system 100”). In some examples, thecomponents and systems of the safety and security system 100 of thisdisclosure can be supported by other mounting supports, including butnot limited to a boom-mounted rack system, a wheeled rack system and abed 103 mounting bracket. One or more computers including processingcircuitry 157, of the safety and security system 100 of this disclosuremay be conveniently and safely housed inside the module 101.

In some examples, it is anticipated that some or all of the componentsof the safety and security system 100 of this disclosure could be usedin other healthcare settings such as the intensive care unit, theemergency room or on the ward. As shown in FIG. 1 , the module 101 maybe mounted on an IV pole 105 or other suitable mounting structurelocated near the patient 102.

In some examples, a touch-screen electronic record display 126 canconvert to a qwerty-type keyboard to allow uncommon anesthetic andsurgical events or deviations from pre-recorded scripts, to be manuallydocumented. This allows the standard computer keyboard that is used fordata entry in most electronic anesthetic records, to be eliminated.Standard keyboards are known to be contaminated with pathogenicorganisms and are nearly impossible to clean and decontaminate due totheir irregular surfaces. In contrast, the smooth glass or plastic faceof a touch-screen monitor is easy to clean with no crevasses to hideorganisms.

In some examples, the safety and security system for IV medications 100of this disclosure can include a system for automatically measuring andrecording the administration of IV medications. In some examples, thesystem for automatically measuring and recording the administration ofIV medications includes a medication identification and measurementsystem 128. In some examples, aspects of the safety and security system100 can be provided together with or separately from other aspects ofthe IV medication identification and measurement system 128(hereinafter, “medication identification and measurement system 128”).Likewise, aspects of the medication identification and measurementsystem 128 can be provided together with or separately from otheraspects of the safety and security system 100.

FIG. 2 illustrates an isometric view of an example safety and securitysystem 200 for generating an automated electronic anesthetic recordlocated proximate to a patient 202. Features of the safety and securitysystem 100 of FIG. 1 may be included in the safety and security system200 of FIG. 2 , and vice-versa, therefore all aspects may not bedescribed in further detail. Like numerals can represent like elements.Aspects of FIGS. 1 and 2 may also be described together. Some aspects ofFIG. 2 , including an IV fluid identification and measurement system130, are described with respect other figures, including the descriptionof IV fluid identification and measurement system 1430 of FIG. 14 .

As shown in FIG. 2 , an example medication identification andmeasurement system 228 may be attached to a relocation module 201 thatmay be advantageously positioned proximate the patient 202, such as nearthe patient's head on a surgical table 212. In this position medicationscan be conveniently administered by medical personnel while also tendingto and observing the patient 202 during surgery.

In some examples, the medication identification and measurement system128 (FIG. 1 ), 228 (FIG. 2 ) may include one or more sensors, such asone or more of: a barcode reader or QR code reader (e.g., 436, FIG. 4 ),a radio-frequency identification (RFID) interrogator (e.g., 438, FIG. 4), or any other suitable sensor for accurately and reliably identifyinga medication for IV administration. As defined herein, a barcode readercan include any other type of identifying reader, such as, but notlimited to, a QR code reader. Likewise, the RFID interrogator can be anytype of interrogator and is not limited to those interrogators based onradio frequency. Examples of such sensors are described herein, such asin FIGS. 4 and 5 .

In some examples, instead of, or in addition to one or more of an RFIDinterrogator 438 and a barcode reader 436, the medication identificationand measurement system 128, 228 can receive an input to determine theidentity. For example, the medication identification and measurementsystem 128, 228 can include one or more of: a sensor, such as barcodereader 436 of FIG. 4 , configured to identify the one or more IVmedications or fluids, or an input configured to receive the identity ofthe one or more IV medications or fluids, such as via the anestheticrecord input component 224.

In some examples, the barcode reader (e.g., 436, FIG. 4 ) may be a“computer vision” or “machine vision” camera with the capability ofreading barcodes. The term “machine vision” is often associated withindustrial applications of a computer's ability to see, while the term“computer vision” is often used to describe any type of technology inwhich a computer is tasked with digitizing an image, processing the datait contains and taking some kind of action. In this disclosure the terms“machine vision” and “computer vision” may be used interchangeably.Traditionally, machine vision includes technology and methods used toprovide imaging-based automatic inspection and analysis, processcontrol, and robot guidance. Machine vision is sometimes used inmanufacturing environments. Machine vision refers to many technologies,software and hardware products including processing circuitry,integrated systems and methods.

The inventors have discovered that machine vision can be useful beyondits traditional uses. The inventors discovered that machine vision canbe advantageous in implementing a safety and security system 100, 200because it offers reliable measurements, gauging, object recognition,pattern recognition and liquid fill level measurements. Machine visiondoes not get tired or distracted. Machine vision excels at quantitativemeasurement of a structured scene because of its speed, accuracy andrepeatability. However, it does require the scene to be structured toperform the desired function.

Machine vision can be very accurate for measuring size of an object at aknown distance or the distance of an object of known size. However, itcannot do both. Therefore, in some examples it is important to know theexact location of a syringe (e.g., 406, FIG. 4 ) and thus know thedistance from the camera (e.g., 436, FIG. 4 ) to the syringe (e.g., 406,FIG. 4 ) in order for the machine vision to calculate the distance ofthe movement of the plunger (e.g., 446, FIG. 5 ) within the syringe(e.g., 406, FIG. 5 ). This is what we mean by the “scene beingstructured.”

Machine vision may be advantageous for the safety and security system100, 200 of this disclosure because it “sees” and measures, but does nottouch or interfere with the healthcare provider doing their normal jobof injecting medications or administering IV fluids. Further, the samevisual image that is used by the machine vision software can betransmitted and displayed on a screen 126, 226 to give the operator(whose fingers can be pushing the plunger 446 of the syringe 406, aclose-up view of the syringe 406. FIG. 5 is a cross-section view takenat 5-5 of FIG. 4 . The machine vision camera 436 can be looking at thesame view of the syringe 406 as the operator and it is the same orsimilar view that the operator would see if they were injecting IVmedications the traditional way.

The machine vision camera, or digital camera, can include machine visionsoftware, or the machine vision camera can be in electricalcommunication with (e.g., operably coupled to) one or more hardwareprocessors, such as processing circuitry 157, 257 and one or moremachine-readable mediums 159, 259. The one or more machine-readablemediums 159, 259 can include instructions (e.g., software), that whenimplemented on the processing circuitry 157, 257, can perform thefunctions described herein. The processing circuitry 157, 257 can bestored in the module 101, relocation module 201 or remote from themodules 101, 201 (e.g. in a wired or wireless manner). The one or moremachine-readable mediums 159 can be a storage device, such as a memorylocated in the module 201 or remote from the module 101, 201.

In some examples, the RFID interrogator 438 may be either High Frequency(HF) or Near Field (NF) RFID in order to advantageously limit theread-range to a distance of less than 12 inches. In some examples, theRFID read-range may advantageously be limited, such as to less than 8inches so that only a specific medication injection is identified at anytime. In a possibly more preferred example, the RFID read-range may belimited to less than 4 inches to further prevent mis-readings. NF-RFIDhas a short read-range by definition and the read-range of HF-RFID canbe easily limited by restricting the size of the antenna on the tag. Incontrast, longer read-range RFID such as Ultra-high Frequency (UHF-RFID)may confusingly interrogate every RFID tag in the operating room andthus be unable to identify which medication is being delivered to themedication identification and measurement system 128, 228. However, anysuitable RFID range for a particular application may be used.

FIG. 3 illustrates a plan view of an example of preloaded syringes 306Aand 306B that can be used with the safety and security system 200 ofFIG. 2 .

The one or more preloaded syringes 306A and 306B may be labeled with aunique barcode label 307 or an RFID tag 308 that may identify one ormore of the drug, the concentration, the lot number, the expirationdate, the manufacturer and other important information. In someexamples, a unique barcode label 307 may be a “2-D” barcode label inorder to include more information on a smaller area than traditionalbarcode labels. In some examples, the barcode label 307 or RFID tag 308includes the drug identifying label 309A and 309B for convenient use bythe caregiver.

In some examples, the syringes 306A and 306B can be filled at the pointof use and may be labeled with drug labels 309A and 309B and eitherbarcode labels 307 or RFID tags 308 that are removably attached to thedrug bottle or vial at the factory or pharmacy. The drug labels 309A and309B and either barcode labels 307 or RFID tags 308 may be easilyremoved from the drug bottle or vial and adhesively attached to thesyringe 306A or 306B at the time that the syringe 306A or 306B is loadedwith the drug by the caregiver. Instead of, or in addition to thebarcode labels 307 or RFID tags 308, any other suitable “tag/reader”system known in the arts, may be used.

FIGS. 4-10 illustrate examples of medication identification andmeasurement systems 428, 628, 828 that can be used with the safety andsecurity systems 100, 200 of FIGS. 1 and 2 . However, aspects of themedication identification and measurement systems 428, 628 and 828 maybe used with other systems, and other medication identification andmeasurement systems may be used with the safety and security systems100, 200. Furthermore, some examples of the safety and security systems100, 200 can omit aspects of the medication identification andmeasurement systems, or can omit a medication identification andmeasurement system altogether. FIG. 4 illustrates a portion of a safetyand security system 400 including a side view of an example medicationidentification and measurement system 428 and a syringe 406 that can beused with the safety and security systems 100, 200 of FIGS. 1 and 2 , tomonitor drug delivery. FIG. 5 illustrates a cross-sectional view of themedication identification and measurement system 428 and the syringe 406(not shown in cross-section) of FIG. 4 , taken along line 5-5. FIGS. 4and 5 are described together.

As shown in FIGS. 4 and 5 , the medication identification andmeasurement system 428 may include at least one injection portal 411.The injection portal 411 may be a receptacle for accommodating a syringe406 in a fixed and known location and can be configured to orient theLuer taper connector 513 to mate with an injection port 515. Theinjection port 515 can be secured within the injection portal 411 andcan be in fluid communication with IV tubing 520. In some examples, theinjection portal 411 may include an injection portal tube 416, such as atransparent tube that is sized to receive and accommodate a syringebarrel 418 of a syringe 406. In some examples, the injection portal canbe configured to receive a specific size syringe barrel 418. In someexamples, multiple injection portals 411 can be provided to accommodatesyringes 406 of different sizes.

FIG. 6 illustrates a portion of a safety and security system 600including a side view of a second example of a medication identificationand measurement system 628 and a syringe 606 that can be used with thesafety and security systems 100, 200 of FIGS. 1 and 2 , to monitor drugdelivery. FIG. 7 illustrates a cross-sectional view of the secondexample of a medication identification and measurement system 628 andthe syringe 606 (not shown in cross-section) of FIG. 6 , taken alongline 7-7. FIGS. 6 and 7 are described together.

As shown in FIGS. 6 and 7 , the injection portal 611 of the medicationidentification and measurement system 628 may be large enough toaccommodate syringes 606 of multiple sizes within the space defined by areal or imaginary injection portal tube 616. In this example, accuratelyorienting the Luer taper connector 713 to mate with an injection port715 may be accomplished by one or more orienting members such as one ormore spring positioning members 622A-F that engage with the syringebarrel 618 to center it in the injection portal 611. In some examples,there may be two or more rows of spring positioning members 622A-F. Forexample, spring positioning members 622A, B, E, F may be located nearthe entrance to the injection portal 611 and spring positioning members622C, D may be located near the injection port 715 to assure accuratepositioning for mating with the Luer taper connector 713. Springpositioning members 622A-F may include not only spring wires or metal orpolymer or plastic spring pieces but any flexible material orcombination of materials or shapes that can be deformed by the syringebarrel 618 entering the injection portal 611 and retain a memory (e.g.,elastically deformable, substantially elastically deformable,resiliently deformable, resilient member) so as to urge the syringebarrel 618 into a centered position within the space defined by a realor imaginary injection portal tube 616.

One objective of the spring positioning members 622A-F can be to“automatically” center and align the Luer taper connector 713 of thesyringe 606 with the injection port 715, so that the operator can simplyand conveniently push the syringe 606 into the injection portal 611 andno further manual alignment may be needed. The spring positioningmembers 622A-F can also obviate the need for the operator to toucheither the Luer taper connector 713 of the syringe 606 or the injectionport 715, thus beneficially preventing accidental infectiouscontamination by the operators' fingers and gloves.

FIG. 8 illustrates a portion of a safety and security system 800including a side view of a third example of a medication identificationand measurement system 828 and a syringe 806 that can be used with thesafety and security systems 100, 200 of FIGS. 1 and 2 . FIG. 9illustrates a cross-sectional view of the third example of a themedication identification and measurement system 828 and the syringe 806(not shown in cross-section) of FIG. 8 , taken along line 9-9. FIGS. 8and 9 are described together.

As shown in FIGS. 8 and 9 , a syringe barrel 818 may be centered andheld in place by one or more orienting members, such as compressionpositioning members 842A,B. The compression positioning members 842A, Bmay be urged apart by inserting the syringe barrel 818 there between.Springs 844A-D can compress and create a pressure pushing thecompression positioning members 842A,B against syringe barrel 818. Thecompression positioning members 842A,B shown in FIGS. 8 and 9 are merelyillustrative, and many other sizes, shapes, numbers and locations ofcompression positioning members 842 are anticipated.

Compression positioning members 842A,B may be simple spring 844A-Dactivated devices (e.g., resilient members) as shown in FIGS. 8 and 9 ormay be any mechanism that can expand (e.g., resiliently expand) toaccommodate syringe barrels of various sizes and urge the syringe barrel818 into a centered position within the space defined by a real orimaginary injection portal tube 816. This example shows spring 844A-Dactivated compression positioning members 842A,B but many othermechanical activation mechanisms are anticipated. The compressionpositioning members 842A,B can be elastically deformable, substantiallyelastically deformable, resiliently deformable, include one or moreresilient members.

Other examples of positioning members designed to hold an insertedsyringe 806 in the center of the injection portal 811 and thus orientingthe Luer taper 913 for mating with the injection port 915 areanticipated. Positioning the inserted syringe 806 in the center of theinjection portal 811 allows the machine vision to work from a knowndistance and thus calculations of syringe plunger 948 movement can bevery accurate.

In some examples, instead of the positioning members shown in theexamples of FIGS. 6-9 holding a syringe centrally, the positioningmembers 622A-F or 842A,B can be designed to hold an inserted syringe606, 806 at a known, but off center position in the injection portal611, 811, such as when the injection port 715, 915 (FIGS. 7 and 9 ) ispositioned off center in the injection portal 611, 811. Any arrangementof at least one positioning member that aligns an inserted syringe at aknown position may be provided.

In some examples, and as shown in FIGS. 4, 6 and 8 the medicationidentification and measurement system 428, 628, 828 of this disclosuremay include one or more “machine vision” cameras 436, 636, 836 thatinput digital images into one or more processors having processingcircuitry 157, 257 as shown and described in FIGS. 1,2 , that isprogramed to analyze machine vision images. In some examples, one of theimages that the machine vision cameras 436, 636, 836 may “see” is abarcode label 307 on the syringe 406, 606, 806, that has been insertedinto the injection portal 411, 611, 811, for identifying the medicationin the syringe 406, 606, 806. As previously noted, the barcode label 307can identify the brand name and/or generic name of the medication in thesyringe. In some examples, the barcode label 307 also may identify oneor more of the concentration of the medication, the lot number, theexpiration date and other information that may be useful for inventorymanagement.

As shown in FIGS. 4, 6 and 8 , the safety and security system 400, 600,800 of this disclosure can include one or more radio frequencyidentification (RFID) interrogation antennas 438, 638, 838 that inputRFID information into a processor, such as processing circuitry 157, 257as shown and described in FIGS. 1 and 2 , that is programed to analyzeRFID data. In some examples, the RFID interrogation antennas 438, 638,838 can interrogate a RFID tag 308 (FIG. 3 ) attached to the syringe406, 606, 806, that has been inserted into the injection portal 411,611, 811, for identifying the medication in the syringe 406, 606, 806.In some examples, short range RFID such as near field (NF) or highfrequency (HF) may be advantageous because they may only detect thesyringe 406, 606, 806 that is adjacent to or inside the security systemfor IV medications 400, 600, 800, and not detect the various othermedication syringes that may be sitting on the worktable such as206A-206C in FIG. 2 .

As shown in FIGS. 4, 6 and 8 the medication identification andmeasurement system 428, 628, 828 of this disclosure may include a RFIDinterrogator 438, 638, 838. In some examples, the RFID interrogator 438,638, 838 that can include antennas that may be located inside themedication identification and measurement system 428, 628, 828. In someexamples, the RFID interrogator antennas 438, 638, 838 may be locatedexternal to but proximate the medication identification and measurementsystem 428, 628, 828. As the syringe 406, 606, 806 is brought intoproximity of the medication identification and measurement system, theRFID interrogator 438, 638, 838 can interrogate the RFID tag 308 on thesyringe 406, 606, 806, thereby accurately and reliably identifying amedication for IV administration. In some examples, the RFID tag 308 orother marker may include one or more of: the generic and brand name ofthe drug, the concentration, the lot number, the expiration date, themanufacturer and other important information that may be recorded. Insome examples, the generic and brand name of the drug and theconcentration of the drug can be displayed in the injection section of adisplay such as the display 126, 226 (FIGS. 1, 2 ).

Machine vision is very accurate for measuring the size of an object at aknown distance or the distance of an object of known size. However, itcannot do both. Therefore, in some examples it is important to know theexact location of a syringe and thus know the distance from the camerato the syringe in order to accurately calculate the distance of themovement of the plunger within the syringe.

Syringes are available in multiple sizes such as 3 cc, 6 cc and 12 cc,each of which is a different diameter. The machine vision processor mustknow both the internal diameter of the barrel of the syringe and thedistance that the syringe plunger moves down the barrel, in order tocalculate the volume of medication injected, unless it has anothersource of information. The machine vision of this disclosure can measurethe diameter of the syringe because in the examples the syringe 406,606, 806 is held at known distance and in a centered location relativeto the machine vision cameras 436, 636, 836. Alternately, the securitysystem for IV medications 400, 600, 800 of this disclosure may beprogramed to know that the particular hospital uses only Monoject®syringes for example and the internal diameter of each Monoject® syringesize may be pre-programed into the computer. In this case, the machinevision only needs to differentiate 3 cc, 6 cc and 12 cc syringe sizesfrom each other. The machine vision processor can determine the internaldiameter of the barrel of the syringe. In some examples, the syringesize may be included in the information provided by the barcode 307 orRFID 308 (FIG. 3 ).

In some examples, such as the examples of FIGS. 4-9 , the machine visionsystem, including the machine vision camera 436, 636, 836 and theprocessor 157, 257 of FIGS. 1 and 2 (e.g., processing circuitry) inelectrical communication with the machine vision camera 436, 636, 836,can visually detect and determine other geometry information about thesyringe 406, 606, 806 besides the outside diameter, such as determiningthe inside diameter, or the inner or outer length of the syringe. Themedication identification and measurement systems 428, 628, 828 can usethe geometry information to determine the size or type of the syringe406, 606, 806, or can use the geometry information to calculate a volumeof the syringe 406, 606, 806.

In some examples, as the syringe 406, 606, 806 is advanced into theinjection portal 411, 611, 811, the image of the syringe 406, 606, 806entering the injection portal 411, 611, 811 is displayed in real time inan injection section 126 a, 226 a of the display 126, 226 (FIGS. 1 and 2). Therefore, the caregiver can watch the syringe 406, 606, 806 advanceand engage with the injection port 515, 715, 915. In some examples, theinjection portal tube 416, 616, 816 or the spring positioning members622A-E or the compression positioning members 842A,B, urge the syringe606, 806 into position to mate with the injection port 715, 915 but theactual connection can also be observed as it is happening by thecaregiver on the display 126, 226. Even though the caregiver is notphysically holding the injection port 515, 715, 915 as they typicallywould, they can watch the engagement of the Luer connector 513, 713, 913with the injection port 515, 715, 915 on a display 126, 226, the view isessentially identical to the thousands of injections that they have madeduring their career. In some examples, the actual image of the syringe406, 606, 806 can be displayed on the display 126, 226, while in otherexamples the data obtained by the camera 436, 636, 836 can be convertedto a representation of the syringe displayed on the display 126, 226.

In some examples, once the syringe 406, 606, 806 is securely connectedto the injection port 515, 715, 915, the caregiver pushes on the plunger446, 646, 846 of the syringe 406, 606, 806, injecting the medicationinto the injection port 515, 715, 915 and IV tubing 520, 720, 920. Thecaregiver can visualize the plunger seal 548, 748, 948 move down thesyringe barrel 418, 618, 818 and can determine the volume of medicationinjected by the graduated markings on the syringe 406, 606, 806. Thus,the engagement of the Luer connector 513, 713, 913 with the injectionport 515, 715, 915 and the injected volume are observed by the caregiveron the display 126, 226 and the traditional method and routine ofinjection is minimally altered by implementing the safety and securitysystem 100, 200 including the example medication identification andmeasurement systems 428, 628, 828.

In some examples, the processing circuitry 157, 257 (FIGS. 1 and 2 ) ora computer may also simultaneously generate data representing a runningtotal of the volume and dosage of the injected medication and cantransmit the generated data to the display 126, 226 to display volumeand dosage information on the display 126, 226. In some examples, theprocessing circuitry 157, 257 or a computer may also generate its owngraduated scale and transmit the generated graduated scale informationto the display 126, 226 to superimpose the scale on the image of thesyringe 406, 606, 806 or next to the image of the syringe 406, 606, 806,for added visual clarity of the injected volume and dose.

In some examples, the machine vision determination of the injectedvolume may be calculated by multiplying the internal cross-sectionalarea of the syringe (πr₂) by the distance that the syringe plungermoves. The radius of the syringe may be determined in one or more ways.For example, the machine vision function may determine that the syringeapproximates a 3 cc or 12 cc syringe and the computer is programed toknow that the hospital uses a specific brand of syringes and theinternal diameter (radius) of each of these syringe sizes is preciselyknown. (An example of diameter d, radius r is shown in FIG. 12 ) Anotherexample may require the machine vision camera to measure the outerdiameter of the syringe and then subtract an approximated wall thickness(either measured or known value stored in a memory) from the measureddiameter to determine the internal diameter. In another example, theinternal diameter of the syringe may be supplied to the processingcircuitry 157, 257 or a computer as part of the RFID 308 or barcode 307information. In another example, the machine vision may determine theinner diameter of the syringe by determining an outer diameter of theplunger as viewed through the transparent or semi-transparent syringeand determine the wall thickness, In yet another example, the machinevision may be able to visibly determine the inner diameter or radiusdirectly through the transparent or semi-transparent syringe. Any othersuitable determination, calculation or algorithm may be used todetermine the radius, diameter and injected volume.

In some examples, the machine vision determination of the distance thatthe syringe plunger 446, 646, 846 moves may be by “observing” themovement of the black rubber plunger seal 548, 748, 948 against thevisible scale printed on the syringe 406, 606, 806. In this example, themachine vision can be programed to recognize the markings on the syringe406, 606, 806.

In some examples, the machine vision determination of the distance thatthe syringe plunger 446, 646, 846 moves may be by observing the movementof the black rubber plunger seal 548, 748, 948 relative to a scalecalculated by the processing circuitry 157, 257 (FIGS. 1 and 2 ). Thegeometrical calculation of the scale that determines the distance thatthe syringe plunger 446, 646, 846 moves may be easiest to determinealong the widest part of the syringe that corresponds with the center C(FIG. 12 ) of the syringe 406, 606, 806, which is a known distance fromthe machine vision camera 436, 636, 836. Alternatively, thecomputer-constructed scale may be applied to the side of the syringe406, 606, 806 facing the camera 436, 636, 836, if the radius of thesyringe 406, 606, 806 is subtracted from the known distance to thecenter C (FIG. 12 ) of the syringe 406, 606, 806 in order to calculatethe distance 437 from the machine vision camera 436, 636, 836 to thenear side (e.g., 411A) of the syringe 406, 606, 806.

In some examples, the movement of the black rubber plunger seal 548,748, 948 of the syringe 406, 606, 806 can be clearly identifiable by themachine vision camera 436, 636, 836 and a scale to determine thedistance moved by the plunger 446, 646, 846 can either be “visualized”or constructed by the machine vision computer (e.g., processingcircuitry). Multiplying the distance that the plunger seal 548, 748, 948moves by the known or measured internal diameter d (FIG. 12 ) of thesyringe 406, 606, 806 and thus cross-sectional area of the plunger seal548, 748, 948, allows the processing circuitry 157, 257 or a computer inelectrical communication with the processing circuitry 157, 257 tocalculate an accurate injected volume. The measured injection volume anddosage may be displayed on the display 126, 226 of the module 101, 201(FIGS. 1 and 2 ). Without interfering with or changing theanesthesiologists' normal or traditional medication injection routines,an unobtrusive machine vision camera 436, 636, 836 and computer (e.g.,processing circuitry) can “observe” the medication injections andautomatically record them in the EMR.

In some examples, the injected volume of medication may be determined byother sensors or methods. For example, the systems described herein canemploy (e.g., substitute) other sensors such as a non-visual opticalsensor 436A in place of or in addition to the machine vision camera 436,636, 638 described in FIGS. 4-9 . For example, a light source cab shineon one or more light sensitive elements such as photodiodes, and theposition of the plunger of the syringe can be roughly determined by theobstruction of the light beam by the plunger. Other fluid measurementmethods can have a sensor including adding magnetic material to thesyringe plunger and detecting movement of the plunger with a magneticproximity sensor. Alternatively, fluid flow may be measured with fluidflow meters in the IV fluid stream. These examples are not meant to bean exhaustive list but rather to illustrate that there are alternativetechnologies to machine vision (e.g., sensors), for noncontactmeasurement (e.g., sensing) of fluid flow from a syringe that areanticipated in this disclosure.

Securing the injection port 515, 715, 915 within the injection portal411, 611, 811 prevents the caregiver from touching the injection port515, 715, 915. Normally caregivers wear gloves to protect themselvesfrom infectious contaminates from the patient and operating room andtheir gloves are nearly always contaminated. Anything they touch will becontaminated. They typically pick up and hold the IV injection port 515,715, 915 with one hand while inserting the Luer taper connector 513,713, 913 of the syringe 406, 606, 806 into the injection port 515, 715,915. In the process, the injection port 515, 715, 915 is frequentlycontaminated with pathogenic organisms from their gloves that can enterthe patient's blood stream with the next injection, causing seriousinfections. It is therefore advantageous from the infection preventionpoint of view, if the Luer connection and injection can be accomplishedwhile never touching the injection port 515, 715, 915.

In some examples as shown in FIGS. 4, 6 and 8 the medicationidentification and measurement system 428, 628, 828 can include one ormore ultraviolet (UV) lights 440A, 440B, 640A-D, 840A-D that shine onthe injection port 515, 715, 915. The one or more UV lights can belocated inside the module (e.g., 101, FIG. 1 ) of the medicationidentification and measurement system 128, 228, 428, 628, 828, keepingthe injection portal 411, 611, 811 and the injection port 515, 715, 915disinfected. In some examples, the UV lights 440A, 440B, 640A-D, 840A-Dmay preferably be in the UV-C part of the light spectrum. UV-C light hasbeen shown to have superior germicidal powers over other parts of the UVspectrum. The UV lights 440A, 440B, 640A-D, 840A-D may shinecontinuously or intermittently. By making the injection port 515, 715,915 untouchable because it is inside the module 101 and radiating theinjection port 515, 715, 915 with UV-C light, the injection port 515,715, 915 should be effectively disinfected between each injection andthereby eliminate injection port 515, 715, 915 contamination as a sourceof bloodstream infection.

In some examples as shown in FIGS. 1 and 2 , the safety and securitysystem 100, 200 may include an external reader, such as barcode reader180, 280 on the module 101, 201 to read a barcode, QR code or the likefor identification. This barcode reader 180, 280 may be used to identifythe healthcare provider injecting a medication by reading a barcode orQR code 1186 on the user's ID badge for example (FIG. 11 ). In someexamples as shown in FIGS. 1 and 2 , the safety and security system 100,200 may include an external RFID reader 182, 282 on the module 101, 201.This RFID reader 182, 282 may be used to identify the healthcareprovider injecting a medication by reading an RFID tag 1188 on theuser's ID badge 1184B for example (FIG. 11 ). In some examples as shownin FIGS. 4, 6 and 8 , the safety and security system 400, 600, 800 mayinclude an internal RFID reader 438, 638, 838 in the module 101, 201.This RFID reader 438, 638, 838 may also be used to identify thehealthcare provider injecting a medication by reading an RFID tag on theuser's ID badge for example.

It is an important part of the record to know who injected themedication and their identity can be easily verified and documented bythe safety and security system 400, 600, 800 using either barcode, QRcode or RFID. Other identification technologies are also anticipated.

FIG. 10 illustrates an example injection port cassette 1054 that can beused with the safety and security systems 100, 200 of FIGS. 1 and 2 , asdetailed in FIGS. 5, 7 and 9 . As shown in FIG. 10 , the injection port1015 may be mounted on an injection port cassette 1054 in order to makethe attachment to the safety and security system 100, 200, 400, 600, 800easier and more secure. The injection port cassette 1054 may be a pieceof molded polymer or plastic onto which the injection port 1015 and IVtubing 1020 may be attached. The injection port cassette 1054 may beshaped and sized to fit into a slot in the safety and security system100, 200, 400, 600, 800. When the injection port cassette 1054 is fitinto a slot in the safety and security system 100, 200, 400, 600, 800,the injection port 1015 can be positioned substantially in the center ofthe injection portal 411, 611, 811 for mating with the Luer tapers 513,713, 913. The injection port cassette 1054 can also be configured to beremoved intact from the safety and security system 400, 600, 800 so thatthe patient can be transferred and the IV tubing 1020 can be moved withthe patient and continue to operate normally.

In some examples, and as shown in FIG. 10 , the injection port cassette1054 can include an IV bypass channel 1056 in the IV tubing 1020. The IVbypass channel 1056 can allow the IV fluids to flow unencumbered by themedication injection apparatus. The injection port cassette 1054 caninclude a medication channel 1058 in the IV tubing 1020 and, themedication channel 1058 may include one or more stop-flow clamps1060A,B. The one or more stop-flow clamps 1060A,B may be activated bythe safety and security system 100, 200, 400, 600, 800 if a medicationerror is identified. The one or more stop-flow clamps 1060A,B may bepowered by one or more electromechanical solenoids that squeeze the IVtubing in the medication channel 1058 flat, obstructing the flow. Otherelectromechanical flow obstructers are anticipated.

In some situations, such as when administering a drug to a patientallergic to that drug, or administering potent cardiovascular drugs to apatient with normal vital signs, or administering a drug with a likelymistaken identity, the computer, such as processing circuitry 157, 257(FIGS. 1 and 2 ) for the safety and security system 100, 200, 400, 600,800 of this disclosure can automatically activate the stop-flow clamps1060A,B to compress the medication channel 1058 tubing upstream and/ordownstream from the injection port 1015. Compressing the IV tubing bothupstream and downstream from the injection port 1015 prevents theinjection of any medication into the IV tubing 1020. An alert to theadverse condition of the injection may be displayed on display 126, 226where the stop-flow condition can be over-ridden by the operatortouching a manual override switch on the display 126, 226 or the module101, 201, if the injection was not erroneous. While the stop-flow canoccur in the medication channel 1058, the IV fluid flow can continuenormally in the parallel bypass channel 1056.

The stop-flow clamps 1060A,B can allow the processing circuitry 157, 257(e.g., processor, hardware processing circuitry) of the safety andsecurity system 100, 200, 400, 600, 800 to not only warn the operator ofa pending medication error, but physically prevent the injection.Perhaps equally as important is that the stop-flow clamps 1060A,B can bequickly released by the operator touching a manual override switch inthe event that the apparent error was in fact a planned event orotherwise desired by the operator.

In some examples, a part of the safety and security system 100, 200,400, 600, 800 can include the ability for the computer (e.g., machine)to know the patient's medical history, medication orders, vital signs,current medications, medication orders and other important informationabout that patient. In some examples, the medication in syringe 306 canbe identified by RFID tag 308 (FIG. 3 ) and is detected by RFIDinterrogator 438, 638, 838 as the syringe 306 enters injection portal411, 611, 811. The processing circuitry (e.g., 157, 257) of the safetyand security system 100, 200, 400, 600, 800 can cross-reference theproposed injection to the patient's medical history, medication orders,vital signs, current medications and other important information aboutthat patient, providing a safety “over-watch” guarding againstmedication errors. In some examples, the processing circuitry (e.g.,157, 257) of the safety and security system 100, 200, 400, 600, 800 mayinclude algorithms and/or “artificial intelligence” that can providealternative medication suggestions based on patient's medical history,medication orders, vital signs, current medications and other importantinformation about that patient.

In some examples, the EMRs that were created by the safety and securitysystem 100, 200, 400, 600, 800 of this disclosure can provide accurateand temporally correlated information about the relationship between anyinjected medication and the resulting physiologic response. This isuniquely accurate dose-response data. In some examples, the EMRs thatwere created by the safety and security system 100, 200, 400, 600, 800for hundreds of thousands or even millions of patients, may beaggregated and analyzed as “big data.” The “big data” from these EMRsmay be used for a variety of purposes including but not limited tomedical research, patient and hospital management and the development of“artificial intelligence” algorithms that can provide alternativemedication suggestions. Ongoing “big data” from more and more EMRs canbe used to continually improve and refine the “artificial intelligence”algorithms, much like the “artificial intelligence” algorithmdevelopment process being used to develop self-driving vehicles. These“artificial intelligence” algorithms can be used to provide automated(“self-driving” or “partially self-driving”) anesthesia during surgeryor automated medication delivery.

It is well known that scheduled drugs such as Fentanyl and othernarcotics are frequently stolen by drug addicted healthcare personnel.The final link in the “chain of custody” between when the drugs arechecked out from a vending system such as a pharmacy or Pixis medicationdispenser, and when the drugs are injected into the patient is missing.The final link in the “chain of custody” between when the drugs arechecked out from the pharmacy and when the drugs are injected into thepatient is totally dependent on the personal integrity of the healthcareprovider. It is also impractical for each narcotic injection to bepersonally monitored by a second healthcare provider. Without a complete“chain of custody,” even a second provider monitoring the injection maynot be adequate to prevent medication pilferage. Addicted healthcareproviders frequently substitute saline for a clear medication such asthe narcotic Fentanyl—injecting the saline and keeping the Fentanyl forthemselves. Addicted healthcare providers have been known tosuccessfully steal their patient's narcotics for years before beingcaught.

In some examples, the safety and security system 100, 200, 400, 600, 800of this disclosure provides a “chain of custody” between when drugs arechecked out from the pharmacy or Pixis medication dispenser, and whenthe drugs are injected into the patient. The “chain of custody” providessecurity especially for scheduled drugs such as narcotics. The “chain ofcustody” provided by the safety and security system 100, 200, 400, 600,800 makes it nearly impossible to steal the patient's narcotics. Theadded security provided by the safety and security system 100, 200, 400,600, 800 significantly increases the chances of getting caught, thuscreating a disincentive for addicted healthcare providers stealing theirpatient's drugs.

FIG. 11 illustrates a plan view of an example of healthcare provider IDbadges 1184A and 1184B that can be used with the system of FIGS. 1 and 2, in accordance with at least one example. In some examples, the “chainof custody” may begin by electronically identifying the healthcareprovider as the drugs are checked out from the pharmacy or Pixismedication dispenser. In some examples and as shown in FIG. 11 , eachprovider can have a personalized RFID tag 1186, attached to theirhospital ID badge 1184A. In some examples each provider can have apersonalized barcode 1188, attached to their hospital ID badge 1184B forexample. When the drugs are checked out, the personalized RFID tag 1186may be read by an RFID interrogator or the personalized barcode 1188read by a barcode reader in the pharmacy and the ID of the providerchecking the drugs out may be noted in the hospital's computer and/orthe processing circuitry 157, 257 (FIGS. 1 and 2 ) for the safety andsecurity system 100, 200, 400, 600, 800 (FIGS. 1, 2, 4, 6 and 8 ). Thespecific RFID 308 or barcode 307 (FIG. 3 ) identification of theinjectable drug may also be recorded before the drug leaves the pharmacyand that information may be transmitted to the processing circuitry 157,257 of the safety and security system 100, 200, 400, 600, 800 of thisdisclosure. In some examples, instead of an RFID tag 1186 and RFIDreader, other provider identification information and sensors foridentifying the provider can be used, such provider identificationinformation may include: a barcode, a QR code with the sensor being ableto read such codes. In other examples, the sensor can include a retinalscanner, fingerprint reader or a facial recognition scanner thatidentifies the provider by personably identifiable information (e.g.,provider identification information) may be used.

In some examples, non-refillable preloaded syringes may be used toprevent pilferage of the drugs between leaving the pharmacy and arrivingat the patient's bedside. It is a well-known practice for providers tosteal drugs by pocketing the bottle, vial or ampule and then filling thesyringe with saline for injection into the patient. Pre-loaded syringesremove the opportunity for the provider to pilfer drugs while loading asyringe from a bottle, vial or ampule. A non-refillable syringe makes itdifficult or even impossible to discharge the narcotics from a preloadedsyringe into a second syringe and then refill the discharged syringewith saline or other clear fluids.

In some examples, when the provider arrives at the patient's bedside,the provider may be identified by their ID badge 1184 A,B. In someexamples, an ID badge 1184A that has an RFID tag 1186 may be read byRFID reader 182, 282 (FIGS. 1 and 2 ) that can be located on the safetyand security system 100, 200, 400, 600, 800 or by RFID reader 438, 638,838 (FIGS. 4, 6 and 8 ) located inside the safety and security system100, 200, 400, 600, 800 (FIGS. 1, 2, 4, 6 and 8 ). In some examples, anID badge 1184B that has a barcode 1188 may be read by barcode reader180, 280 that can be located on the safety and security system 100, 200,400, 600, 800. In some examples, a retinal scanner may be located on ornear module 101, 201 in order to positively identify the provider bytheir retinal vasculature. Other scanners including but not limited tofacial recognition scanning are also anticipated in order to positivelyidentify the provider doing the injection in order to automaticallydocument this information to an EMR or other record.

In some examples, the provider's photograph may be taken by camera 190,290 (FIGS. 1 and 2 ) for further identification before allowing theinjection of scheduled drugs. In some examples, the camera 190, 290 maybe triggered, such as by processor 157, 257 (FIGS. 1 and 2 ), when asyringe e.g., 306B filled with a scheduled drug such as a narcotic isidentified as it enters the injection portal 411, 611, 811 and the RFIDinterrogator 438, 638, 838 interrogates the RFID tag 308 (FIG. 3 ) orthe machine vision camera 436, 636, 836 reads the barcode 307 (FIG. 3 )on the syringe 306A. Non-scheduled medications may not need the addedsecurity of a photograph.

In some examples, when the syringe, such as 406, 606, 806, filled with ascheduled drug such as a narcotic enters the injection portal 411, 611,811, the RFID interrogator 438, 638, 838 interrogates the RFID tag 308or the machine vision camera 436, 636, 836 reads the barcode 307 on thesyringe 306A, 306B. At that point, the safety and security system 100,200, 400, 600, 800 of this disclosure can have documented, such as byrecording to memory one or more of: 1.) the specific drug syringe thatwas checked out of the pharmacy and is now inside the injection portal411, 611, 811; 2.) the ID of the provider injecting the drug; 3.) the IDof the provider who checked the drug out of the pharmacy 4.) the patientwho is being injected and 5) the time of the injection. The processingcircuitry 157, 257 can include or be electrically connected to a timerand a memory to facilitate recording the time.

In some examples, the machine vision camera 436, 636, 836 of the safetyand security system 100, 200, 400, 600, 800 “watches” the injectionoccur and documents that it occurred. When the injection has occurred,the “chain of custody” is complete for that dose of the scheduled drug.If all of the drug in the syringe is not injected, the safety andsecurity system 100, 200, 400, 600, 800 can document the non-injecteddrug. The remaining non-injected drug may be “closed out” in the systemby being administered to the patient in a second or third injection orby being properly disposed of and manually documented.

In some examples, in order for the safety and security system 100, 200,400, 600, 800 to assure a “chain of custody” for a given drug, the drugmay come from the pharmacy in a pre-loaded syringe that may betamper-proof and non-refillable. There are many ways that narcotics suchas Fentanyl have been pilfered by healthcare personnel. First, if thedrug is delivered in a vial, ampule or bottle, it may not be transferredinto the injection syringe by the provider. The syringe may be refilledwith another fluid such as saline instead and the narcotic may be put inthe provider's pocket. Therefore, in some examples, prefilled syringesmay be desirable to assure the last link in the “chain of custody”between the pharmacy and the patient is complete.

Another well-known opportunity for stealing drugs in the healthcaresetting is from a syringe that has been filled with a drug such as anarcotic. Very simply, some or all of the drug in the syringe can bedischarged into another syringe or container and then the first syringecan be refilled with saline looking exactly like it did before thedischarge. To prevent this method of drug pilferage, the syringes usedfor narcotics should be non-refillable. Filling a standard syringe isnormally accomplished by pulling on the plunger that is attached to theplunger seal—a rubber gasket mounted on the end of the plunger. Thedistal end of the plunger is knob-shaped and it fits into a pocket-likereceptacle in the plunger seal that captures the knob of the plunger andpulls the plunger seal along when the plunger is pulled from thesyringe.

FIG. 12 illustrates a longitudinal cross-sectional view of an example ofa medication security syringe that can be used with the system of FIGS.1 and 2 . In some examples, and as shown in FIG. 12 , the normal methodof filling a syringe 1206 can be prevented by replacing the knob-shapeddistal end of the traditional plungers (e.g., 446, 646, 846) with atubular-shaped distal end 1292 as of plunger 1246. If the plunger 1246is retracted from the syringe 1206, the relatively smooth sides of thedistal end 1292 of the plunger 1246 disengage easily from the plungerseal 1248, preventing the plunger seal 1248 from creating the vacuumnecessary to refill the syringe 1206.

In some examples, an enterprising drug thief could overcome the factthat relatively smooth sides of the distal end 1292 of the plunger 1246disengage easily from the plunger seal 1248, by forcing fluid into theopen end 1294 of the Luer taper 1213. Fluid such as saline underpressure would fill the syringe from the Luer taper end 1213 and forcethe plunger seal 1248 rearward as the syringe 1206 fills with fluid. Insome examples, a spring wire barb 1296 or other metal protrusion forminga barb may be molded into or attached to rubber plunger seal 1248. Insome examples, the tips 1298A,B of spring wire barbs 1296 may be angledrearward away from the Luer taper 1213 and compressed inward by thewalls of the barrel of syringe 1206. The rearward angle of spring wirebarbs 1296 allow the rubber plunger seal 1248 with its attached orimbedded spring wire barbs 1296 to be pushed forward in a normal fashionby plunger 1246, discharging the contents of the syringe 1206.

In some examples, if fluid such as saline under pressure was attemptedto be forced into the syringe 1206 from the Luer taper 1213 end forcingthe plunger seal 1248 rearward, the tips 1298A,B of spring wire barbs1296 can gouge into the soft polymer or plastic (e.g., polyethylene orpolypropylene) of the walls of the barrel of syringe 1206 and prevent arearward movement of plunger seal 1248. Therefore, when the syringe 1206has discharged it contents, it cannot be reloaded or refilled. Thespring wire barbs 1296 as shown in FIG. 12 are an example of using abarb or ratchet effect to allow movement of plunger seal 1248 in onedirection and prevent movement of plunger seal 1248 in the otherdirection. Other barb or ratchet mechanisms that accomplish this sameeffect are anticipated.

In some examples, an enterprising drug thief could overcome the fact thesyringe 1206 of this disclosure cannot be reloaded or refilled, byremoving the contents of the syringe 1206 without depressing the plunger1246. This can be accomplished in prior art syringes by inserting ahypodermic needle attached to a second syringe, through the opening inthe Luer taper 1213 connector and sucking out the contents of syringe1206. A third syringe filled with saline can then be used to refillsyringe 1206 by inserting a hypodermic needle through the opening in theLuer taper 1213 connector and injecting the saline. Therefore, in someexamples, it may be advantageous to make the syringe tamper-proof byadding a mechanical barrier on either end of the Luer taper connector1213 that physically prevents a hypodermic needle from entering syringe1206.

In some examples, as shown in FIG. 12 , a mechanical barrier may beadded in the form of needle blocking insert 1291. In an example, theneedle blocking insert 1291 may be a piece of molded polymer, plastic orrubber that can be inserted into the barrel of syringe 1206 and pusheddown to the closed end. The needle blocking insert 1291 can include asmall metal plate 1293 that is positioned directly in front of theopening in the Luer taper connector 1213 in order to prevent ahypodermic needle that may be inserted into the open end 1294 of theLuer taper 1213 connector from entering the barrel of syringe 1206.Depending on the specifics of the design, without a metal plate 1293, asharp hypodermic needle may be able to be pushed through the polymer,plastic or rubber needle blocking insert 1291 and into the barrel ofsyringe 1206. The piece of metal 1293 can be retained in a recess 1293Ain the needle blocking insert 1291. Although the needle blocking insert1291 is described as including metal plate 1293, any suitable needleblocking insert that prevents a needle from being inserted into the openend of the Luer taper 1213 can be provided within the scope of thisdisclosure.

In some examples, as shown in FIG. 12 , the needle blocking insert 1291may include transverse fluid channels 1295 and/or longitudinal fluidchannels 1297. The transverse and or longitudinal fluid channels 1295,1297 may be molded into needle blocking insert 1291 allowing the fluidin syringe 1206 to flow through needle blocking insert 1291 during anormal injection but preventing needle penetration, such as by a drugthief. In some examples, the needle blocking insert 1291 may be coupledby attachment 1299 to syringe 1206 in order to prevent dislodgement. Theattachment 1299 between the needle blocking insert 1291 and the barrelof syringe 1206 may be a heat bond, an ultrasonic bond, and RF bond, anadhesive bond or other mechanical attachment such as a pressure fit.

FIG. 13 illustrates a longitudinal cross-sectional view of an example ofa medication security syringe 1306 that can be used with the system 100,200 of FIGS. 1 and 2 . In some examples, as shown in FIG. 13 , ahypodermic needle may be prevented from entering the open end 1394 ofthe Luer taper 1313 connector by adding a serpentine or zig-zag fluidchannel 1381 to the open end 1394 of the Luer taper 1313 connector. Insome examples, the serpentine or zig-zag fluid channel 1381 may be madeof molded polymer or plastic that creates an extended Luer taperconnector 1383. The molded serpentine or zig-zag fluid channel 1381 mayinclude a hub 1385 that mates with Luer taper 1313 connector and isconnected to Luer taper 1313 connector by a heat bond, an ultrasonicbond, and RF bond or an adhesive bond. The serpentine or zig-zag fluidchannel 1381 prevents a stiff hypodermic needle or even a flexiblecatheter from navigating the sharp corners of the fluid channel 1381. Insome examples, the molded components described herein can be alternatelyformed, such as by 3D printing.

By preventing the movement of plunger seal 1248 after the syringe hasbeen discharged and preventing the insertion of a hypodermic needlethrough the open end 1294, 1394 of the Luer taper 1213, 1313 connectorin order to suck out the drug and then reload the syringe 1206, 1306with saline, the syringes 1206, 1306 of FIGS. 12 and 13 are resistant toundetected drug theft.

In some examples as shown in FIGS. 1 and 2 , the safety and securitysystem 100, 200 of this disclosure may include a remote monitor withdisplay 187, 287. The remote monitor may include a wired or wirelessconnection to the safety and security system 100, 200 and may displaysome or all of the information shown on the electronic record display126, 226, or other information generated by the safety and securitysystem 100. For example, the processing circuitry 157, 257 can be inelectrical communication with the remote display 187, 287 and theprocessing circuitry 157, 257 can send instructions to the remotedisplay 187, 287 to display the generated information.

The remote monitor may be in the next room or miles away. The remotemonitor may allow remote supervision of healthcare delivery. Forexample, anesthesiologists frequently supervise up to four surgicalanesthetics at once, each being delivered by a nurse anesthetist. Inthis case, the anesthesiologist carrying a wireless remote monitor 187,287 can have real-time data on each case under their supervision.Similarly, a nurse anesthetist working in a rural hospital may besupervised by an anesthesiologist who is 50 miles away.

In some examples, the remote monitor with display 187, 287 can create arecord for billing. For example, when an anesthesiologist is supervisingmultiple anesthetics at once, the payers may dispute the involvement ineach case and refuse to pay. The remote monitor with display 187, 287may include an RFID reader that documents the close proximity of an RFIDtag on the anesthesiologist's ID badge. Any other type of proximitysensor may be used in place of the RFID tag, including but not limitedto GPS location sensing. Documenting that the anesthesiologist wascarrying the remote monitor with display 187, 287 throughout the time ofthe surgery is very good evidence that the anesthesiologist was activelyparticipating in the care of the patient.

In some examples, the remote monitor with display 187, 287 allowslong-distance medical consultation. For example, an expert at the MayoClinic could consult with a physician halfway around the world in Dubai,responding to real-time patient data displayed on the remote monitorwith display 187, 287.

FIG. 14 illustrates a side view of an example IV fluid identificationand measurement system 1430 that can be used with the systems of FIG.1-9 , and the injection port cassette of FIG. 10 . Some aspects of FIGS.1-10 and 14 are described together, however, the examples are merelyillustrative and the features can be used in any suitable combination.In some examples, the safety and security system 100, 200 of thisdisclosure includes a system for automatically measuring and recordingthe administration of IV fluids. To accomplish this, as shown in FIGS.1, 2 and 14 , the safety and security system 100, 200 can include an IVfluid identification and measurement system 130, 230, 1430. In someexamples, the IV fluid identification and measurement system 130, 230,1430 can be mounted onto module 101.

Alternately, the IV fluid identification and measurement system 130,230, 1430 may be mounted to an IV pole 105 or racking system independentfrom the module 101. The system for automatically measuring andrecording the administration of IV fluids is not limited to use inanesthesia or in the operating room, but has applicability for usethroughout the hospital and other health care settings, including butnot limited to the ICU, ER, wards, rehabilitation centers and long termcare settings. In some examples, aspects of the IV fluid identificationmeasurement system 130, 230, 1430 can be provided alone or together withother features of the safety and security system 100, 200 including themedication identification and measurement system 128, 228.

In some examples, the IV fluid identification and measurement system130, 230, 1430 may be configured to accommodate one or more bags of IVfluid 132, 232A,B and 1432A,B. Each bag of IV fluid can include a dripchamber 134, 234A,B and 1434A,B and IV tubing 120, 220A,B and 1420A,B.IV flow rates may be controlled with the traditional manually operatedroller clamp that variably pinches the IV tubing 120, 220A,B and 1420A,Bto control or even stop the flow of IV fluids. In some examples, IV flowrates may be controlled with the automatically operatedelectromechanical flow rate clamps 1478 that variably pinch the IVtubing 1420A to control or even stop the flow of IV fluids. Theautomatically operated electromechanical flow rate clamps 1478 may becontrolled by the processing circuitry 157, 257, such as an electronicanesthetic record computer in module 101 or by any other suitableprocessor including hardware processing circuitry that is in electricalcommunication with the IV fluid identification and measurement system130, 230, 1430 and/or is located within the IV fluid identification andmeasurement system 130, 230, 1430.

In some examples, the IV fluid identification and measurement system130, 230, 1430 is configured to automatically measure and record theadministration of IV medications and fluids. The system 130, 230 caninclude one or more of a barcode reader and an RFID interrogator (suchas 1436A,B) for accurately and automatically identifying a fluid for IVadministration. Because of the close proximity to the adjacent bags,barcode identification may be preferable in order to prevent an RFIDinterrogator from reading the RFID tag on a neighboring bag. In someexamples, as shown in FIG. 14 , one or more barcode labels 1405A,B maybe applied to the IV bags 1432A,B in a location where they can be readby a sensor such as a barcode reader or machine vision camera 1436A,B,or another machine vision camera located in a suitable position to readthe barcode. In some examples, a dedicated barcode reader or a machinevision camera may be positioned adjacent the barcode label 1405A,Blocation, specifically for reading the barcode label 1405A,B.

In some examples, the drip chamber 234A,B and 1434A,B of the IV set canbe positioned adjacent the one or more machine vision cameras 1436A,B.In some examples, a standard background 1468A,B may be positioned on theopposite side of the drip chamber 1434A,B from the machine visioncameras 1436A,B. The standard background 1468A,B may be a plainbackground or may be an advantageous color, pattern, color design orillumination that highlights each of the falling drops, for easieridentification by the processing circuitry 157, 257 (e.g., 1502, FIG. 15). The machine vision software including instructions can be stored onone or more machine-readable mediums (such as 1522 in FIG. 15 ) thatwhen implemented on hardware processing circuitry (including but notlimited to processing circuitry 157, 257) or in electrical communicationwith the system, can perform the functions described herein. An exampleof such electrical connection is shown by the connection of processor1502 with mass storage 1516 in FIG. 15 .

In some examples, the processing circuitry 157, 257, 1502 can beconfigured to look for a fluid meniscus 1464A,B in the drip chamber1434A,B. In this case “seeing” a fluid meniscus 1464A,B indicates thatthere is fluid in the drip chamber 1434A,B and therefore the IV bag1432A,B is not empty, and air is not inadvertently entering the IVtubing 1420A, 1420B.

In some examples, if the IV fluid identification and measurement system130, 230, 1430 fails to “see” a fluid meniscus 1464A,B meaning that thedrip chamber 1434A,B is empty and thus the IV bag 1432A,B is empty,stop-flow clamps 1460A,B can be automatically activated. For example,processing circuitry 157, 257 can send an instruction to activate thestop-flow clamps 1460A,B to compress the IV tubing 1420A,B in order toprevent air from entering the IV tubing 1420A,B. In some examples, theempty IV bag 1432A,B condition detected by the processing circuitry 157,257 can cause an alert to be displayed to the caregiver on theanesthetic record display 226, such as by sending an instruction to thedisplay.

The combination of the machine vision camera 1436A,B in electricalcommunication with processing circuitry (e.g., 157, 257, FIGS. 1 and 2 )that executes instructions stored on a machine readable medium can countthe number of drops of fluid per unit of time in a drip chamber 1434A,Bto calculate or to estimate the flow rate of an IV. The size of the dripchamber 1434A,B inlet orifice determines the volume of liquid in eachdrop. The inlet orifices of standard drip chambers are sized to createdrops sizes that result in 10, 12, 15, 20, 45 and 60 drops per ml. Givena particular drop volume (size), 10 drops per ml for example, the system130, 230, 1430 (e.g., via sensors, processing circuitry and machinereadable medium) can count the number of drops falling in a known periodof time and use that data to calculate or to estimate the flow rate. Ifthese estimates were attempted by a human, they may be less accurate athigher flow rates (higher drop counts) because the drops are so fast, itcan be difficult to count the drops. Eventually, at even higher flowrates the individual drops become a solid stream of fluid and the flowrate cannot be visually estimated.

In some examples, the IV fluid identification and measurement system130, 230, 1430 is configured to look for falling drops of fluid 1462A,Bwithin the drip chamber 1434A,B. When drops 1462A,B have beenidentified, the machine vision system (e.g., machine vision camera 1436Aor 1436B operably coupled to processing circuitry 157, 257) may firstmeasure the diameter of the drop 1462A,B to determine which of thestandard drop sizes or volumes it is counting. Most hospitalsstandardize on several infusion set sizes, 10, 20 and 60 drops per ccfor example. Therefore, when these limited choices of infusion setbrands and sizes have been programed into the computer, the machinevision system only needs to differentiate between these choices, whichis much easier than accurately measuring the diameter of the drops.Unlike the human eye, the machine vision can accurately count thefalling drops even at high flow rates to calculate an IV fluid flowrate.

In some examples, the machine vision system, including the machinevision cameras 1436A,B and instructions 1524 (e.g., software) stored ona machine readable medium 1522 and implemented by hardware processingcircuitry 157, 257 does not “see” falling drops 1462A,B. In thissituation, either the fluid is flowing in a steady stream that is notidentifiable or the fluid has stopped flowing. In some examples, thesetwo opposite conditions can be differentiated by inserting a floatingobject 1466A,B (hereinafter, “float”) into the drip chambers 1434A,B. Insome examples, the float 1466A,B may be a ball-shaped float 1466A,B. Insome examples, the float may be patterned or multi-colored to moreeasily identify movement or spinning of the float. In some examples, ifthe machine vision system cannot identify falling drops 1462A,B, it thenlooks to the float 1466A,B for additional information. If the float1466A,B is not moving or spinning, the fluid flow has stopped. If thefloat 1466A,B is moving or spinning and drops cannot be identified, thefluid is flowing in a steady stream and the flow rate cannot be measuredby machine vision. In this situation, the system can determine fluidflow using an alternate method.

In some examples, the IV fluid identification and measurement system130, 230, 1430 may be configured to accommodate one or more bags of IVfluid 132, 232A,B, 1432A,B and each of these IV bags may be hanging froman electronic IV scale 1472A,B (e.g., a weight, a physicalcharacteristic sensor). The electronic IV scale 1472A can measure thecombined weight of the IV bag and fluid 1432A, the drip chamber 1434Aand the IV tubing 1420A. The electronic IV scale 1472B can measure theweight or combined weight of one or more of the IV bag and fluid 1432B,the drip chamber 1434B, the IV tubing 1420B and a pressure infuser 1474.In both of these examples, the electronic IV scale 1472A,B canaccurately measure the change in combined weight that occurs due to thedrainage of the IV fluid from the IV bag 1432A,B. The change in weightper unit time can be converted to flow rates by processing circuitry157, 257 in electrical communication with the electronic IV scale 1472A,1472B, for example, by the processing circuitry 157, 257, 1502 anddisplayed on the electronic record display 126, 226.

In some examples, the calculated flow rates for each IV bag 1432A,B mayalso be displayed on one or more digital flow-rate displays 1476A,Bmounted on the IV fluid identification and measurement system 1430. Thedigital flow-rate displays 1476A,B may be small LED or LCD displays thatconveniently tell the operator the flow rate while they are manuallyadjusting the flow rate near the IV bags 1432A,B and drip chambers1434A,B. The digital flow-rate displays 1476A,B are particularlyconvenient when the IV fluid identification and measurement system 130,1430 is a free standing entity mounted on an IV pole 105 for examplewhile being used on the ward or ICU.

In some examples, when the falling drops 1462A,B cannot be detected andyet the floats 1466A,B are moving or spinning, the fluid is determinedto be flowing in a steady stream and the flow rate cannot be measured bymachine vision. In this case the electronic record computer mayautomatically query the change in weight per unit time as measured bythe electronic IV scale 1472A,B to determine the IV flow rate. At highflow rates, the change in weight per unit time as measured by theelectronic IV scale 1472A, B will most likely be more accurate thancounting drops, in determining the IV flow rate.

The IV flow rate as determined by the change in weight per unit time canalso be compared to the IV flow rates determined by counting drops toverify the accuracy of each method. Without interfering with or changingthe healthcare providers normal or traditional IV routines, anunobtrusive machine vision camera and computer can “observe” the IV flowrates and automatically record them in the EMR.

The module or automated EMR system 101, 201 of this disclosure maycapture anesthetic event data but it must be noted that the sametechnologies described herein for capturing anesthetic event data can beused throughout the hospital or outpatient health care system to captureand record medication administration, IV fluid administration, vitalsigns and patient monitor inputs, provider events and other data.Non-operating room heath care locations are included within the scope ofthis disclosure. While this disclosure focuses on the totality offunctions offered by module 101, 201, each of the individual functionscan be offered independently of module 101, 201.

The use of the term Electronic Anesthetic Record (EAR) as defined hereincan include any memory such as an electronic surgical record (ESR), oran electronic medical record (EMR), and is not limited to anesthetic orsurgical applications. Aspects of the modules 101,201 described hereincan also be employed in recovery, hospital room and long-term caresettings.

In an example, the module 201 of FIG. 2 , can include a housing 299having a lower section 299A and a tower-like upper section 299B, whereinthe lower section 299A can be configured to house unrelated wasteheat-producing electronic and electromechanical surgical equipment, andwherein the tower-like upper section 299B can be located on top of thelower section 299A. The module 201 can also include a cowling 299Cexternal or internal to the housing 299 that substantially confineswaste heat generated by the unrelated waste heat-producing electronicand electromechanical surgical equipment. In addition, the module 201can include a system for monitoring the administration of one or more IVmedications and fluids 228, 230. As shown in the combination of FIGS. 2,4, 5 and 14 , the system 228, 230 can include any of: a barcode 436reader or an RFID 438 interrogator configured to identify the one ormore IV medications or fluids; a machine vision digital camera 436 tocapture an image of one or more of a syringe 406 or a drip chamber1434A,B; processing circuitry 257 operably coupled to the barcode reader436 or the RFID interrogator 438 (or the machine vision digital camera436) to receive the identity of the one or more IV medications orfluids, the processing circuitry 257 operably coupled to the machinevision digital camera 436 to receive the captured image and determine avolume of medication administered from the syringe or fluid administeredfrom an IV bag based on the image; and a display 226 operably coupled tothe processing circuitry 257, the display 226 configured to receiveinstructions from the processing circuitry 257 to output the identityand determined volume of medication administered from the syringe orfluid administered from an IV bag.

FIG. 15 illustrates an example electronic and/or electromechanicalsystem 1500 of a medical system in accordance with some examplesdescribed herein. The system 1500 will be described with respect to themedical system 20, but can include any of the features described hereinto perform any of the methods or techniques described herein, forexample, by using the processor 1502. The processor can includeprocessing circuitry 157 or 257 of FIGS. 1 and 2 . In some examples, theprocessing circuitry 1502 can include but is not limited to, electroniccircuits, a control module processing circuitry and/or a processor. Theprocessing circuitry may be in communication with one or more memory andone or more storage devices. A single processor can coordinate andcontrol multiple, or even all the aspects of the system 1500 (e.g., ofmodules 101, 201), or multiple processors can control all the aspects ofthe system 1500. In some examples the storage device 1516 or memory1504, 1506, 1516 can include at least a portion of the patient'sanesthetic record saved thereon. The system 1500 can also include any ofthe circuitry and electronic and/or electromechanical componentsdescribed herein, including but not limited to, any of the sensor(s)described herein (e.g., sensors 1521), such as but not limited to, RFIDbarcode or QR codes sensors, machine vision cameras, retinal scanners,facial recognition scanners, fingerprint readers, actuators and positionsensors described herein. The system 1500 may also include or interfacewith accessories or other features such as any of: a remote display orwireless tablet (e.g., 287, FIG. 2 ), as well as any of the othersystems described herein.

The processing circuitry 1502 can receive information from the varioussensors described herein, make various determinations based on theinformation from the sensors, output the information or determinationsfrom the information for output on the display or wireless tablet,output instructions to provide an alert or an alarm, power variouscomponents, actuate actuators such as clamps and flow managing devices,etc., or alert another system or user, as described herein. For the sakeof brevity, select systems and combinations are described in furtherdetail above and in the example sets provided in the Notes and VariousExamples section below. Other embodiments are possible and within thescope of this disclosure.

Further, FIG. 15 illustrates generally an example of a block diagram ofa machine (e.g., of module 101, 201) upon which any one or more of thetechniques (e.g., methodologies) discussed herein may be performed inaccordance with some embodiments. In alternative embodiments, themachine 1500 may operate as a standalone device or may be connected(e.g., networked) to other machines. In a networked deployment, themachine 1500 may operate in the capacity of a server machine, a clientmachine, or both in server-client network environments. The machine1500, or portions thereof may include a personal computer (PC), a tabletPC, a personal digital assistant (PDA), a mobile telephone, a webappliance, a network router, switch or bridge, or any machine capable ofexecuting instructions (sequential or otherwise) that specify actions tobe taken by that machine. Further, while only a single machine isillustrated, the term “machine” shall also be taken to include anycollection of machines that individually or jointly execute a set (ormultiple sets) of instructions to perform any one or more of themethodologies discussed herein, such as cloud computing, software as aservice (SaaS), other computer cluster configurations.

Examples, as described herein, may include, or may operate on, logic ora number of components, modules, or like mechanisms. Such mechanisms aretangible entities (e.g., hardware) capable of performing specifiedoperations when operating. In an example, the hardware may bespecifically configured to carry out a specific operation (e.g.,hardwired). In an example, the hardware may include configurableexecution units (e.g., transistors, circuits, etc.) and a computerreadable medium containing instructions, where the instructionsconfigure the execution units to carry out a specific operation when inoperation. The configuring may occur under the direction of theexecution units or a loading mechanism. Accordingly, the execution unitsare communicatively coupled to the computer readable medium when thedevice is operating. For example, under operation, the execution unitsmay be configured by a first set of instructions to implement a firstset of features at one point in time and reconfigured by a second set ofinstructions to implement a second set of features.

Machine (e.g., computer system) 1500 may include a hardware processor1502 (e.g., processing circuitry 157, 257, a central processing unit(CPU), a graphics processing unit (GPU), a hardware processor core, orany combination thereof), a main memory 1504 and a static memory 1506,some or all of which may communicate with each other via an interlink(e.g., bus) 1508. The machine 1500 may further include a display unit1510, an alphanumeric input device 1512 (e.g., a keyboard), and a userinterface (UI) navigation device 1514 (e.g., a mouse). In an example,the display device 1510, an input device such as an alphanumeric inputdevice 1512 and UI navigation device 1514 may be a touch screen display.The display unit 1510 may include goggles, glasses, or other AR or VRdisplay components. For example, the display unit may be worn on a headof a user and may provide a heads-up-display to the user. Thealphanumeric input device 1512 may include a virtual keyboard (e.g., akeyboard displayed virtually in a VR or AR setting.

The machine 1500 may additionally include a storage device (e.g., driveunit) 1516, a signal generation device 1518 (e.g., a speaker), a networkinterface device 1520, and one or more sensors 1521, such as a globalpositioning system (GPS) sensor, compass, accelerometer, or othersensor. The machine 1500 may include an output controller 1528, such asa serial (e.g., universal serial bus (USB), parallel, or other wired orwireless (e.g., infrared (IR), near field communication (NFC), etc.)connection to communicate or control one or more peripheral devices oractuators of the system. Peripheral devices can include but are notlimited to any displays, controllers or memories in electricalcommunication with the system, and actuators can include but are notlimited to: one or more stop-flow clamps 1060A,B (FIG. 10 ) and one ormore flow rate clamps 1478 (FIG. 14 ) of the system.

The storage device 1516 may include a machine readable medium 1522 thatis non-transitory on which is stored one or more sets of data structuresor instructions 1524 (e.g., software) embodying or utilized by any oneor more of the techniques or functions described herein. Theinstructions 1524 may also reside, completely or at least partially,within the main memory 1504, within static memory 1506, or within thehardware processor 1502 during execution thereof by the machine 1500. Inan example, one or any combination of the hardware processor 1502, themain memory 1504, the static memory 1506, or the storage device 1516 mayconstitute machine readable media that may be non-transitory.

While the machine readable medium 1522 is illustrated as a singlemedium, the term “machine readable medium” may include a single mediumor multiple media (e.g., a centralized or distributed database, orassociated caches and servers) configured to store the one or moreinstructions 1524.

The term “machine readable medium” may include any medium that iscapable of storing, encoding, or carrying instructions for execution bythe machine 1500 and that cause the machine 1500 to perform any one ormore of the techniques of the present disclosure, or that is capable ofstoring, encoding or carrying data structures used by or associated withsuch instructions. Non-limiting machine readable medium examples mayinclude solid-state memories, and optical and magnetic media. Specificexamples of machine readable media may include: non-volatile memory,such as semiconductor memory devices (e.g., Electrically ProgrammableRead-Only Memory (EPROM), Electrically Erasable Programmable Read-OnlyMemory (EEPROM)) and flash memory devices; magnetic disks, such asinternal hard disks and removable disks; magneto-optical disks; andCD-ROM and DVD-ROM disks.

The instructions 1524 may further be transmitted or received over acommunications network 1526 using a transmission medium via the networkinterface device 1520 utilizing any one of a number of transferprotocols (e.g., frame relay, internet protocol (IP), transmissioncontrol protocol (TCP), user datagram protocol (UDP), hypertext transferprotocol (HTTP), etc.). Example communication networks may include alocal area network (LAN), a wide area network (WAN), a packet datanetwork (e.g., the Internet), mobile telephone networks (e.g., cellularnetworks), Plain Old Telephone (POTS) networks, and wireless datanetworks (e.g., Institute of Electrical and Electronics Engineers (IEEE)802.11 family of standards known as Wi-Fi®, IEEE 802.16 family ofstandards known as WiMax®), IEEE 802.15.4 family of standards,peer-to-peer (P2P) networks, among others. In an example, the networkinterface device 1520 may include one or more physical jacks (e.g.,Ethernet, coaxial, or phone jacks) or one or more antennas to connect tothe communications network 1526. In an example, the network interfacedevice 1520 may include a plurality of antennas to wirelesslycommunicate using at least one of single-input multiple-output (SIMO),multiple-input multiple-output (MIMO), or multiple-input single-output(MISO) techniques. The term “transmission medium” shall be taken toinclude any intangible medium that is capable of storing, encoding orcarrying instructions for execution by the machine 1500, and includesdigital or analog communications signals or other intangible medium tofacilitate communication of such software.

Method examples described herein may be machine or computer-implementedat least in part. Some examples may include a computer-readable mediumor machine-readable medium encoded with instructions operable toconfigure an electronic device to perform methods as described in theexamples. An implementation of such methods may include code, such asmicrocode, assembly language code, a higher-level language code, or thelike. Such code may include computer readable instructions forperforming various methods. The code may form portions of computerprogram products. Further, in an example, the code may be tangiblystored on one or more volatile, non-transitory, or non-volatile tangiblecomputer-readable media, such as during execution or at other times.Examples of these tangible computer-readable media may include, but arenot limited to, hard disks, removable magnetic disks, removable opticaldisks (e.g., compact disks and digital video disks), magnetic cassettes,memory cards or sticks, random access memories (RAMs), read onlymemories (ROMs), and the like.

Some of the benefits of the safety and security systems 100, 200 ofFIGS. 1 and 2 and the subsystems described throughout this disclosure,and including the machine 1500 (FIG. 15 ), can include features to helpwith monitoring medication, fluid and anesthesia delivery, as well asdocumenting medication, fluid and anesthesia delivery, as well as otherfunctions. In general, doctors and nurses are not interested inreplacing themselves and their jobs with automated drug delivery orautomated anesthesia systems. However, there is great interest inautomated record keeping. Virtually all healthcare providers wouldprefer the “old” paper record and a pen to the “new” computer records.Filling out the electronic medical record (EMR) using a computerkeyboard, mouse and various menus is widely viewed as a slow, cumbersomeand distracting process. The challenge with automated record keeping isautomating the data input that documents the numerous activities,anesthesia related events, fluid, gas and medication administration,ventilator settings, pressure off-loading effectiveness, as well asoutputs such as blood loss and urine output, that constitute ananesthetic experience.

A challenge in implementing the safety and security system and fluids100, 200 with an automated electronic anesthetic record (EAR) orelectronic medical record (EMR) is to force as little change in thecaregiver's routine as possible onto the clinicians using this system.Medical personnel tend to be creatures of habit and tradition and theygenerally do not like change. For example, IV medications aretraditionally administered from a syringe and the dose is determined bythe caregiver observing the plunger moving relative to a scale printedon the syringe. Maintaining this general technique of drugadministration may have the highest probability of acceptance byhealthcare users who are typically slow to embrace changes in theirroutine.

Further with regard to benefits of the modules, systems and machinesdescribed herein, the safety and security system 200 of module 201 cangenerate an automated electronic medical record (EMR) with the module201 locatable proximate to the patient 202. The module 201 can be amodule for housing unrelated electronic and electromechanical surgicalequipment. The module 201 need not necessarily be configured to houseunrelated electronic and electromechanical surgical equipment in allexamples, and other modules can include the system for generating anautomated EMR.

The module 201 can be an automated EMR system that can include one ormore systems (e.g., 200, 228, 230) configured to measure (e.g., monitor)and record one or more of functions involved in a surgical anestheticenvironment, and can include life support functions. The one or moresystems 228, 230 can measure and record data automatically. However, insome examples, a user may initiate any of the systems described hereinto measure and/or record data. These various measurements may beelectronically recorded (such as on mass storage 1516 (FIG. 15 ) anddisplayed on the electronic anesthetic record display 226 (e.g., displaydevice 1510, FIG. 15 ). Inputs to the automated EMR system may bemanaged by the anesthetic record input component 224 (e.g., input device1512; FIG. 15 ). The anesthetic record input component 224 (e.g., inputdevice 1512; FIG. 15 ) can include a touch-screen display 226 thatorganizes all of the inputs to the EMR into easily accessed and utilizedinformation. In some examples, and as shown in FIG. 2 , theidentification and measurement system 228 of this disclosure may belocated proximate the patient 202. The control displays for theidentification and measurement system 228 may include a dedicateddisplay proximate the identification and measurement system 228 or maybe shared space on the anesthetic record input component 224 or display226. In these locations, the information and controls of theidentification and measurement system 228 can be viewed by theanesthesiologist or other user, in a single field of vision with thepatient and surgical field.

Example methods of employing the systems, modules and machines disclosedherein are described throughout this disclosure and in the methods ofFIGS. 16-21 which are illustrative in nature. Other methods describedherein may also be performed by the systems, modules and machinesdescribed herein, and the systems modules and machines described hereinmay be used to perform other methods.

FIGS. 16-18 show flow charts illustrating techniques for identification,measurement, monitoring, security and safety related to medicationsand/or IV fluids. The methods may be used with the systems, sub-systemsand modules of FIGS. 1-15 (e.g., 101, 201, 1500), but may also be usedwith other systems. Likewise, the systems, subsystems of modules ofFIGS. 1-15 may also be used with other methods. The techniques 1600,1700, 1800, 1900, 2000, 2100, 2300 can be performed by at least onenon-transitory machine-readable medium (e.g., computer readable)including instructions for operation of the systems described herein.Some steps of techniques may be performed by a provider. The systems caninclude processing circuitry (e.g., 157, 257, 1500, including one ormore processors, processing circuitry hardware) for executing theinstructions. The instructions, when executed by the processingcircuitry can cause the processing circuitry to perform operationsdescribed in FIGS. 16-21 and 23 , and as described in the examplesthroughout this disclosure.

FIG. 16 is a flow chart illustrating an example technique 1600 of IVfluid identification and measurement. To start the technique, inoperation 1602 a provider hangs an IV fluid bag and attached dripchamber on electronic scale hooks in an IV fluid identification andmeasurement unit (e.g., FIG. 14 ). In operation 1604, a machine visioncamera and software can identify the fluid and bag by the barcode labelon the IV fluid bag. In operation 1606, the machine vision camera andsoftware can identify the individual drops in the drip chamber andmeasure the size of the drop to determine the fluid volume per drop andcount the number of drops per unit time. In operation 1608 the machinevision camera and software can calculate the flow rate by multiplyingthe number of drops per unit time by the volume/drop. In operation 1610,the fluid flow rate is displayed and document in the EMR.

In operation 1612, if the machine vision camera and software fails toidentify individual drops in the drip chamber, in operation 1614 themachine vision camera and software can look for a floating ball (e.g.,float) that is located in the drip chamber to determine if the ball isfloating and if the ball is moving. In operation 1616, when the ball isnot floating and/or moving, IV clamps are closed and the provider canchange the empty IV bag if necessary. In operation 1618, if the machinevision camera and software can determine that the ball is floating andmoving, the system determines that the fluid flow is so fast that thefluid flow is constant or continuous such that individual drops cannotbe measured. In operation 1618, because individual drops cannot bedetermined, the system switches to measuring the fluid flow rate usingan electronic IV scale (FIG. 14 ) to determine the fluid flow rate. Inoperation 1620, the fluid flow rate can be determined by monitoring thechange in IV bag weight per time. In operation 1622, the fluid flow ratecan be displayed and documented in the EMR.

FIG. 17 is a second flow chart illustrating a technique 1700 includingaspects of the technique 1600 of IV fluid identification and measurementfrom the perspective of processing circuitry (e.g., 257, FIG. 2 ; 1502,FIG. 15 ). The technique 1700 may include an operation 1702 to receiveIV fluid identification information from a first IV sensor (e.g., one ormore sensors), such as an RFID or barcode reader to identify the fluidor other characteristics of an IV fluid bag as described herein.Operation 1704 can include saving the IV identification information to astorage device (e.g., one or more storage devices, memory, EMR).Operation 1706 can include to receive fluid drop information from asecond IV sensor, such as a machine vision camera that detects, sensesand measures an individual drop in a drip chamber to determine a fluidvolume per drop and measure the number of drops per unit of time. Whilethe illustrative example of FIG. 17 includes the first IV sensor and thesecond IV sensor, in some examples the first IV sensor and the second IVsensor can be the same sensor or same one or more sensors. Operation1708 can include to determine if a fluid drop was recognized by thesecond IV sensor. If in operation 1708 it is determined that a fluiddrop was recognized, operation 1710 can include determining a fluid flowrate, such as by calculating the flow rate by multiplying the number ofdrops per unit time by the volume per drop. In some examples, the volumeper drop is measured, while in other examples the volume per drop may beinput by a user, or can be a value retrieved from a memory. Operation1712 can include transmitting instructions to a display to cause a fluidflow rate to be displayed. Operation 1714 can include saving flow rateinformation to the storage device to document the fluid flow rate in theEMR. Any time a change is input or detected in the system, updated flowrate information can be displayed and saved.

If in operation 1708 it is determined that a fluid drop was notrecognized, operation 1616 can include receiving float information fromthe second IV sensor or another IV sensor. The float information caninclude information about a float in the drip chamber including is thefloat still (e.g., not moving), moving, or is movement of the floatslowing down. Operation 1718 can include determining if the float ismoving. If the float is moving, Operation 1720 can include determiningthe fluid flow is constant. In such a scenario, the fluid is flowing butthe fluid is flowing so quickly that individual drops of fluid cannot bedistinguished because the fluid is flowing as a steady stream. Operation1720 can further include determining the fluid flow rate by receiving IVbag physical characteristic information from a physical characteristicsensor, such as a weight sensor. The physical characteristic informationcan include weight information from the weight sensor (e.g., scale).Operation 1722 can include determining the fluid flow rate bycalculating the change in IV bag weight over a period of time. In otherexamples, instead of weight information, the physical characteristicinformation can include a position of the IV bag that changes as aresult of a change in weight, without the physical characteristic datacorresponding directly to a weight measurement. Other physicalcharacteristics and other physical characteristic sensors configured tomonitor IV fluid delivery may be provided such that an automated, or atleast partially automated EMR system is enabled.

If in operation 1718 it is determined that the float is not moving,operation 1728 can include determining that no fluid is flowing from theIV bag and transmitting one or more of: an instruction an actuator suchas a clamp, to cause the actuator to inhibit fluid flow to the patient(e.g., close the clamp onto IV tubing to prevent flow); and transmit andinstruction to an indicator (e.g., display, audible, tactile indicator)to cause an alert to be generated. Operation 1730 can include saving ano fluid event to the storage device.

FIG. 18 is a flow chart illustrating an example technique 1800 ofmedication identification and measurement. In operation 1802 a providerinserts a medication syringe into an injection portal (e.g., 411, FIG. 4). In operation 1804 the medication can be identified by a sensor suchas by at least one of the RFID, barcode or QR sensors described herein.In operation 1806 processing circuitry checks for medication errors bycomparing the medication against one or more of: a doctor's orders,allergy history, medical history, other medications and current vitalsigns. In operation 1808, the results of the medication error check canbe displayed on an electronic record display. The results can indicateno error, the presence of an error, specific details about the error, orpresent a link to access information including additional details aboutthe error. In operation 1810, if a serious medication error isrecognized, the error deploys (e.g., causes actuation of) IV tubingclamps (e.g., 1060A, 1060B of FIG. 10 ) to prevent injection of themedication.

If in operation 1812, such as when no errors are determined, the machinevision camera and software can measure the diameter of the syringe. Inoperation 1814, an image of, or representation of the image of thesyringe, is displayed on the electronic record display. In operation1816 the provider squeezes the plunger of the syringe. In operation1818, the machine vision camera and software measure the distancetraveled by the syringe's plunger seal (e.g., 548, FIG. 5 ). Inoperation 1820 the processing circuitry calculates the volume injectedby multiplying the syringe diameter times the distance of plungertravel. The processing circuitry can also calculate the dose bymultiplying the volume injected by the concentration of the medication.In operation 1822 the injected dose and volume are displayed on theelectronic record display. In operation 1824 the injected dose andvolume are time stamped and recorded in the electronic medical record.

FIG. 19 is a second flow chart illustrating a technique 1900 includingaspects of the technique 1800 of medication identification andmeasurement from the perspective of processing circuitry (e.g., 157,FIG. 1 ; 257, FIG. 2 ; 1502, FIG. 15 ).

Technique 1900 can include an operation 1902 to receive medicationidentification information such as medication type, concentration,brand, lot number or amount, from a first medication sensor (e.g., RFID,barcode or QR reader). Operation 1904 can include saving medicationidentification information to a storage device (e.g., one or morestorage devices, memory). Operation 1906 can include comparingmedication identification information to at least one of a medicationorder, allergy history, medical history, other medications ordered forthe patient, and vital signs (e.g., previously obtained vital signs orcurrent vital signs of the patient via continuous monitoring). Operation1908 can include determining if a medication error is present. Operation1910 can include receiving syringe information from a second medicationsensor (e.g., a sensor configured to measure diameter, such as a machinevision camera). Operation 1912A can include receiving medicationdelivery information from the second medication sensor or anothermedication sensor. In some examples, the medication delivery informationcan include a distance of a syringe plunger travel.

Operation 1912B can include transmitting instructions to a display tocause an image of the syringe (e.g., actual image or representation ofthe syringe) to be displayed. A representation of the syringe caninclude an image communicating information about the syringe that is notan image of the actual syringe or can be a modified image of thesyringe, such as to highlight or point out aspects of the syringe ormedication within the syringe

Using the medication delivery information obtained in operation 1912A,operation 1914 can include determining a medication delivery amount.Operation 1916 can include transmitting instructions to a display (e.g.,display 226, FIG. 2 ) to cause the medication delivery information ormedication delivery amount to be displayed.

If in operation 1908 it is determined that a medication error ispresent, operation 1920 can include transmitting instructions includingerror information to the display or another display to cause the errorinformation to be displayed. In some examples, any of the instructionsdescribed herein that are sent to the display can be sent to one or moredisplays. Such displays can be located locally or remotely (e.g., in adifferent part of a room, in a separate room, in another building, inanother state, in another country), to alert multiple providers. Forexample, a provider such as a nurse anesthetist located adjacent to thepatient can be alerted to and provided with the information via display226. In addition, a second provider, such as an anesthesiologistsupporting the nurse anesthetist, and who may be supporting other nurseanesthetists working in different rooms, can also be alerted on adisplay of a mobile device, which may prompt them to check in with andpotentially assist the nurse anesthetist. This concept can be appliedoutside the operating room to manage medication delivered by providersworking in different rooms of a hospital or other care center, while asecond provider such as a nurse manager, nurse practitioner, pharmacistor doctor oversees the work of the first provider. In operation 1922 theerror information can be saved to one or more storage devices (e.g.,259, FIG. 2 ; 1516, FIG. 15 ).

Also in response to determining that a medication error has occurred inoperation 1908, operation 1924 can include transmitting instructions toan actuator such as an IV tubing clamp to inhibit (e.g., prevent,reduce, limit) injection. In some examples, the actuator can reduce orlimit the amount of the injection to a specified amount rather thancompletely inhibiting or preventing administration of the medication.Operation 1926 can include saving an inhibit injection event informationto a storage device, such as any of the one or more storage devices(e.g., 259, FIG. 2 ; 1516, FIG. 15 ). The inhibit injection eventinformation can include information such as the time of the event andthe action taken to inhibit injection and how much the injection wasinhibited (e.g., partially inhibited, completely inhibited, or amount ofmedication inhibited from injection).

If in operation 1908 it is determined that a medication error has notoccurred, operation 1910 can include receiving syringe informationincluding a syringe diameter from a sensor such as a machine visioncamera. In some examples, the sensor can be the first medication sensoror can be a second medication sensor. Operation 1912A can includereceiving medication delivery information from a sensor such as from thefirst medication sensor, the second medication sensor or another sensor.The medication delivery information can include a distance of plungertravel relative to a syringe body. Operation 1912B can includetransmitting instructions to one or more displays such as, display 226,FIG. 2 , to cause an image of the syringe or representation of thesyringe to be displayed.

Operation 1914 can include determining a medication delivery amount,such as a volume or dose injected. For example, the volume injected canbe calculated by multiplying the syringe diameter by the distance ofplunger travel. The dose injected can be calculated by multiplying thevolume injected by the concentration of the medication.

Operation 1916 can include transmitting instructions to the one or moredisplays to cause the medication delivery information to be displayed.Operation 1918 can include saving medication delivery information to thestorage device (e.g., EMR). In some examples, the medication deliveryinformation can include, but is not limited to, volume, dose, time ofthe injection, or time period of the injection.

FIG. 20 is a flow chart illustrating an example of a second technique ofIV fluid identification and measurement including safety and securitymeasures. Aspects of technique 2000 can be similar or the same astechniques 1800 and 1900, however, technique 2000 is particularlywell-suited to the challenges of maintaining safety and security withcontrolled drugs such as narcotics. Technique 2000 can include operation2002 of identifying a medication (e.g., a controlled drug) andidentifying a health care provider, such as by RFID, barcode or QR codereader, retinal scanner, facial recognition, or fingerprint. Operation2002 can occur at the time a provider checks out a drug from a pharmacyor a medication dispensing machine. The medication can include anarcotic in a tamper-proof, non-refillable syringe.

Operation 2004 can include identifying a provider such as by RFID,barcode or QR code reader, retinal scanner, facial recognition, orfingerprint at a patient's bedside, such as at an injection portal(e.g., 411, FIG. 4 ). The provider can be the same or a differentprovider as the provider in operation 2002. In operation 2006, theprovider inserts the medication syringe into the patient's injectionportal. In operation 2008, the controlled drug is identified, such as byan RFID, barcode or QR code reader associated with the injection portal.Operation 2010 can include processing circuitry checking for medicationerrors by comparing the medication against doctor's orders, allergyhistory, medical history, other medications and vital signs. Operation2012 can include displaying medication error check results on a display,such as display 226, FIG. 2 . If the medication error is of a seriousnature, the error can cause IV tubing clamps to prevent injection.Operation 2016 can include machine vision camera and software measuringthe diameter of the syringe. Operation 2018 can include an image, or animage representing the syringe being displayed on a display, such asdisplay 226, FIG. 2 . Operation 2020 can include a provider squeezingthe plunger of the syringe. Operation 2022 can include the machinevision camera and software measuring the distance traveled by thesyringe's plunger seal (e.g., 548, FIG. 5 ). Operation 2024 can includeprocessing circuitry determining the volume of medication injected bymultiplying the syringe diameter by the distance of plunger travel ordetermining the dose of medication injected by multiplying the volume ofmedication injected by the concentration of the medication. Operation2026 can include displaying the injected volume or dose on a display,such as display 226, FIG. 2 .

Operation 2028 can include saving the injected volume or dose along witha timestamp to the EMR. Operation 2030 includes repeating the operationsof technique 2000 as necessary until the machine vision camera andsoftware documents an empty syringe. Operation 2032 includes completingthe “chain of custody” for a specific syringe of controlled medication.The operations of technique 2000 can be repeated as necessary for othersyringes, thereby completing the “chain of custody” for each syringe.

FIG. 21 is a second flow chart illustrating a technique 2100 includingaspects of the technique 2000 of IV fluid identification and measurementincluding safety and security measures from the perspective ofprocessing circuitry, such as, but not limited to, processing circuitry157, FIG. 1 ; 257, FIG. 2 ; 1502, FIG. 15 . The technique may involveprocessing circuitry 2202B, such as may be part of a medication vendingsystem as shown in FIG. 22 . FIG. 22 illustrates generally an example ofa block diagram of vending system and a medication delivery system ofFIGS. 1-21 and 23 upon which any one or more of the techniques (e.g.,methodologies) discussed herein may perform in accordance with someembodiments. FIGS. 21 and 22 are described together.

In some examples, operations 2102 and 2104 can be part of a vendingsystem (2202, FIG. 22 ) for managing medication withdrawal from apharmacy or other vending system. Operations 2110-2136 can be part of amedication delivery system (e.g., can be used with the bedside patientsystems and modules shown and describe in FIGS. 1-15 ; medicationdelivery system 2210, FIG. 22 ). Operation 2138 can tie information,including data generated by the vending system 2202 and the medicationdelivery system 2210 together to facilitate tracking a “chain ofcustody” for a specific syringe of controlled medication from thepharmacy until the medication is completely injected into the patient.Chain of custody information can be stored to one or more of: thevending system storage 2202A, the medication delivery storage 2216, andchain of custody storage device (e.g., 2206, FIG. 22 ) and the EMR. Anyof the storage described herein can include one or more storage devicesor memory as described herein and can include other storage devices inelectrical communication with the vending system or the medicationdelivery system.

Operation 2102 of the vending system can include receiving withdrawingprovider identification information from a medication dispensing sensor2202C, such as a first RFID or barcode reader that reads a badge of aprovider and reads the medication identification information from asyringe or other medication container, or any other type of suitablesensor described herein. Operation 2104 can include associating andsaving the medication identification information and the withdrawingprovider identification information to a vending system storage device(e.g., 2202A, FIG. 22 ).

Operation 2110 can include receiving medication identificationinformation from a first identification sensor (e.g., RFID, QR, barcodereader, or machine vision camera reads information about a medication)and receiving delivery provider identification information from thefirst identification sensor or another identification sensor (e.g., asecond identification sensor, another RFID, QR or barcode reader,machine vision camera, retinal scanner, facial recognition sensor orfingerprint reader). In some examples, patient identificationinformation can also be obtained from one of the first identificationsensor, second identification sensor or another identification sensor,such as by scanning patient identification information on a hospitalwristband. In some examples receiving the medication identification, theprovider identification information or the patient identification cancause the processing circuitry to send an instruction to a display toprompt the user for the other of the medication identificationinformation, the provider identification information or the patientidentification information.

Operation 2112 can include comparing the received identificationinformation to one or more of: a medication order, allergy history,medical history, other medications and current vital signs. Operation2114 can include determining if a medication error is present. If it isdetermined that a medication error is present, operation 2116 caninclude transmitting instructions including error information to adisplay to cause the error information to be displayed. Operation 2118can include saving the error information to one or more storage devices.Further, if in operation 2114 it is determined that a medication errorhas occurred, operation 2120 can include transmitting inhibit injectioninstructions to an actuator such as, but not limited to, an IV tubingclamp (e.g., 1060A, 1060B; FIG. 10 ) to inhibit injection. Operation2122 can include saving an inhibit injection event information to one ormore storage devices.

Operation 2124 can include receiving syringe information from a secondmedication sensor (e.g., syringe diameter including syringe innerdiameter, outer diameter, or wall thickness from a machine visioncamera). Operation 2124 can include receiving syringe size informationfrom a data storage device, the syringe size information provided by thesyringe manufacturer that supplies the specific syringes used by thespecific healthcare facility. Operation 2126 can include transmittinginstructions to a display to cause an image of the syringe or arepresentation of the syringe to be displayed. Operation 2128 caninclude receiving syringe movement information from the secondmedication sensor or another sensor. Syringe movement information caninclude, for example, a distance of travel of the syringe plungerrelative to the syringe barrel.

Operation 2130 can include determining medication delivery informationbased on the syringe movement information. Medication deliveryinformation can include, for example, a volume or dose of medicationdelivered to the patient (e.g., ejected from the syringe). In someexamples, the volume of medication delivered (e.g., ejected from thesyringe) can be calculated by multiplying the syringe inner diameter bythe distance of plunger travel. Likewise, the dose of medicationdelivered can be calculated by multiplying the calculated volume by aconcentration of the medication. Operation 2132 can include savingmedication delivery information to one or more storage devices. In otherwords, operation 2132 can include documenting volume, dose and time inan EMR, in some cases automatically without intervention from aprovider.

Operation 2134 can include transmitting instructions to one or moredisplays described herein to cause the medication delivery informationto be displayed. Operation 2136 can include determining that a syringeis empty and saving “chain of custody” complete for the specific syringeof medication (e.g., controlled drug) to one or more storage devices.

To complete and document the chain of custody, thereby ensuring themedication was delivered to the patient, operation 2138 can include oneor more of receiving, associating and saving to one or more chain ofcustody storage devices (e.g., 2206, FIG. 22 ), information from boththe pharmacy vending system 2202 (FIG. 22 ) and the bedside medicationdelivery system 2210 (FIG. 22 )(e.g., 1516; FIG. 15 ). In some examplesthe one or more chain of custody storage devices is not necessarilyseparate from the vending system storage 2202A or the medicationdelivery storage 2216, but rather can reside with one or the othersystems, a different system, multiple systems or can be included as asingle storage device.

FIG. 23 illustrates and example technique 2300 for assessingphysiological events. In some examples, the EMRs created by the safetyand security system 100, 200, 400, 600, 800 can provide the mostaccurate and temporally correlated information about the relationshipbetween any injected medication and the resulting physiologic response.In some examples, this is uniquely accurate dose-response data can beused as a final check of the chain of custody for controlled medicationsor any medication. The processing circuitry 157, 257 may include or bein electrical communication with artificial intelligence (AI) and/ormachine learning that can compare the measured physiologic response inthe several minutes after a medication is injected, to the expectedphysiologic response for that dose of that medication. For example, ifthe injected medication was a narcotic, it would be expected that theheart rate and blood pressure of the patient would decrease quicklyafter the injection.

In some examples, if the expected physiologic response does not occur,the AI software of the safety and security system 100, 200, 400, 600,800 may electronically “flag” that injection as suspicious. For example,if there is no physiologic response after injecting what was supposed tobe a narcotic, it is possible that the drug had been stolen and replacedby saline. On the other hand, no response may simply mean that thepatient is addicted to and tolerant of narcotics and that too is worthnoting. An unpredicted response does not prove anything but multipleunpredicted responses in multiple patients can be suspicious. Therefore,aggregating or analyzing data over time for a particular patient orprovider can alert management to issues. If any individual providertraverses a threshold number of flags (e.g., too many “flags”) forunexpected physiologic responses (including no response), the safety andsecurity system 100, 200, 400, 600, 800 can generate an alert to notifymanagement and an investigation of that provider may be warranted.Knowing that AI is “watching” the patients' response to a healthcareproviders' injected medications, can be a significant deterrent totempted drug thieves.

Technique 2300 can include determining if one or more unexpectedphysiological events has occurred, analyzing saving, aggregating anddisplaying such information, in any order. The method can be performedby processing circuitry 157, 257, 1502, including other processingcircuitry, memories and databases in electrical communication withprocessing circuitry 157, 257, 1502 to one or more of: receivephysiologic data, analyze physiologic data, determine physiologic datais unexpected, create and send instructions to cause an alert to theprovider or another user, or save a physiological event information to astorage device 1516 which may include a database. The physiologicalevent information can include, but not limited to data generated by thevarious sensors and equipment described herein, including one more of:physiological information, patient information, provider information,medication information, time information, location information, facilityinformation, equipment information, aggregated physiological eventinformation and analyzed physiologic event information.

Operation 2302 can include receiving physiologic data from a physiologicsensor, Operation 2304 can include analyzing the physiologic data.Operation 2304 can include comparing the physiologic data to expectedphysiologic responses. Based on the outcome of the analysis in operation2304, in operation 2306, the processing circuitry can determine if thephysiologic data is unexpected, and if so, operation 2308 can includesaving unexpected physiologic event information to one or more storagedevices, or can include sending instructions to one or more displays todisplay unexpected physiologic event information.

Operation 2310 can include aggregating or analyzing physiologic eventinformation from a plurality of unexpected physiological events andgenerating aggregated or analyzed physiologic event information. In someexamples, aggregating can include aggregating a number of physiologicalevents by counting the number of physiological events for a givenprovider, patient, group of patients, medical facility, type ofmedication, or any other suitable assessment. Operation 2312 can includesaving aggregated or analyzed physiologic event information to one ormore storage devices or sending instructions to one or more displays todisplay aggregated or analyzed physiologic event information. In someexamples, the physiologic event information can include any type ofphysiologic event that occurs, including expected or desirablephysiologic events.

The operations of technique 2300 can help provide safer care forpatients, including providing narcotic medications when helpful, whilekeeping a close eye on drug abuse by providers or patients. Taken at ahigh level, technique 2300 can help medical facilities evaluate whichmedications are most often abused by patients or stolen by providers,and to mitigate risk for insurers.

Any operations of the various methods described herein can be used incombination with or separately from one another, depending on thedesired features and in consideration of constraints such as financial,space, material and manufacturing availability.

The above detailed description includes references to the accompanyingdrawings, which form a part of the detailed description. The drawingsshow, by way of illustration, specific embodiments in which theinvention can be practiced. These embodiments are also referred toherein as “examples.” Such examples can include elements in addition tothose shown or described. However, the present inventors alsocontemplate examples in which only those elements shown or described areprovided. Moreover, the present inventors also contemplate examplesusing any combination or permutation of those elements shown ordescribed (or one or more aspects thereof), either with respect to aparticular example (or one or more aspects thereof), or with respect toother examples (or one or more aspects thereof) shown or describedherein.

In this document, the terms “a” or “an” are used, as is common in patentdocuments, to include one or more than one, independent of any otherinstances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In this document, the terms “including” and “inwhich” are used as the plain-English equivalents of the respective terms“comprising” and “wherein.” Also, in the following claims, the terms“including” and “comprising” are open-ended, that is, a system, device,article, composition, formulation, or process that includes elements inaddition to those listed after such a term in a claim are still deemedto fall within the scope of that claim. Moreover, in the followingclaims, the terms “first,” “second,” and “third,” etc. are used merelyas labels, and are not intended to impose numerical requirements ontheir objects. The terms approximately, about or substantially aredefined herein as being within 10% of the stated value or arrangement.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in combination with each other. Otherexamples can be used, such as by one of ordinary skill in the art uponreviewing the above description. The Abstract is provided to allow thereader to quickly ascertain the nature of the technical disclosure. Itis submitted with the understanding that it will not be used tointerpret or limit the scope or meaning of the claims. Also, in theabove Detailed Description, various features may be grouped together tostreamline the disclosure. This should not be interpreted as intendingthat an unclaimed disclosed feature is essential to any claim. Rather,inventive subject matter may lie in less than all features of aparticular disclosed example. Thus, the following claims are herebyincorporated into the Detailed Description as examples or examples, witheach claim standing on its own as a separate example, and it iscontemplated that such examples can be combined with each other invarious combinations or permutations. The scope of the invention shouldbe determined with reference to the appended claims, along with the fullscope of equivalents to which such claims are entitled.

Notes and Various Examples

Each of these non-limiting examples may stand on its own, or may becombined in various permutations or combinations with one or more of theother examples. The examples are supported by the preceding writtendescription as well as the drawings of this disclosure.

Example 1 is a system for intravenous (IV) medications to deliver amedication from a syringe, the system comprising: a provideridentification sensor configured to identify (e.g., sense) provideridentification information; an injection portal configured to receivethe syringe; one or more medication sensors configured to identifymedication identification information that is coupled to the receivedsyringe when the received syringe is located in the injection portal andconfigured to capture an image of the received syringe; one or moredisplays; one or more storage devices; and processing circuitry that isin electrical communication with the provider identification sensor, theone or more medication sensors, the one or more displays and the one ormore storage devices, wherein the processing circuitry is configured toreceive the provider identification information and to store theprovider identification to at least one of the one or more storagedevices, wherein the processing circuitry is configured to sendinstructions to at least one of the one or more displays to output avisual image or representation of the received syringe on the at leastone display, wherein the processing circuitry is configured to determinea volume of medication dispensed from the received syringe based on animage of the syringe captured by the one or more medication sensors, andwherein the processing circuitry is configured to at least one of: savethe volume of medication dispensed to the one or more storage devices orsend instructions to at least one of the one or more displays to outputthe volume of medication dispensed on the at least one display.

In Example 2, the subject matter of Example 1 includes, wherein theinjection portal further comprises: an injection port that is configuredto fluidly couple to IV tubing; and at least one orienting memberconfigured to guide the received syringe having a diameter that is afirst diameter of a plurality of different diameters, to mate with theinjection port.

In Example 3, the subject matter of Examples 1-2 includes, wherein atleast one of the one or more medications sensors is located to capturean image of an inside of the injection portal, and wherein theprocessing circuitry is configured to receive a captured image of thereceived syringe and to calculate the volume of medication dispensedfrom the received syringe from the captured image by determining aninternal diameter of the syringe and measuring a distance a plunger ofthe received syringe moves to calculate an injected volume.

In Example 4, the subject matter of Examples 1-3 includes, wherein atleast one of the one or more medication sensors is an RFID interrogator,and wherein the medication identification information is an RFID tag.

In Example 5, the subject matter of Examples 1-4 includes, wherein atleast one of the one or more medication sensors is configured to readthe medication identification information and transmit a medicationidentity to the processing circuitry.

In Example 6, the subject matter of Examples 1-5 includes, wherein atleast one of the one or more medication sensors is a machine visiondigital camera.

In Example 7, the subject matter of Examples 1-6 includes, wherein whenthe provider identification sensor is configured to read the provideridentification information and to generate provider identification data,and wherein the processing circuitry is configured to receive thegenerated provider identification information and to compare thegenerated provider identification information to withdrawing providerinformation, wherein the withdrawing provider information includes anidentity of the provider who withdrew the syringe from a vending source.

In Example 8, the subject matter of Example 7 includes, wherein theprovider identification sensor is a barcode reader, an RFIDinterrogator, a retinal scanner, a facial recognition scanner, or afingerprint reader.

In Example 9, the subject matter of Examples 1-8 includes, wherein theprocessing circuitry is configured to send instructions to at least oneof the one or more displays to output one or more of: a brand name of adrug, a generic name of a drug, a drug concentration, a dosage of adrug, a dosage delivered, a fluid flow rate, a fluid volume delivered, apatient allergy, an over-dosing alert, a drug allergy alert and a druginteraction alert.

In Example 10, the subject matter of Examples 1-9 includes, wherein theprocessing circuitry is configured to transmit dispensing information toone or more of: an electronic anesthetic record (EAR) and an electronicmedical record (EMR), to automatically record dispensing informationabout the medication dispensed from the received syringe to the EAR orthe EMR.

In Example 11, the subject matter of Examples 1-10 includes, aninjection port located in the injection portal that is configured tofluidly couple the received syringe to IV tubing; and at least one clampin electrical communication with the processing circuitry, wherein theprocessing circuitry is configured send an instruction to actuate the atleast one clamp positioned one or more of upstream or downstream fromthe injection port, and wherein the processing circuitry is configuredto send instructions to the at least one clamp to inhibit dispensing ofthe medication or an IV fluid when an adverse condition is determined bythe processing circuitry.

Example 12 is a system for intravenous (IV) medications to deliver amedication from a syringe, the system comprising: a provideridentification sensor configured to identify (e.g., sense) a provider;an injection portal configured to receive the syringe; one or moremedication sensors configured to identify medication information that iscoupled to the received syringe when the received syringe is located inthe injection portal, wherein at least one of the one or more medicationsensors is located to capture an image of an inside of the injectionportal; one or more displays; one or more storage devices; andprocessing circuitry that is in electrical communication with theprovider identification sensor, the one or more medication sensors, theone or more displays, and the one or more storage devices, wherein theprocessing circuitry is configured to receive the provideridentification information and to store the provider identification toat least one of the one or more storage devices, wherein the processingcircuitry is configured to send instructions to at least one of the oneor more displays to output a visual image or representation of thereceived syringe on the at least one display, wherein the processingcircuitry is configured to receive a captured image of the receivedsyringe and to calculate a volume of medication dispensed from thereceived syringe from the captured image by determining an internaldiameter of the syringe and measuring a distance a plunger of thereceived syringe moves to calculate an injected volume, and wherein theprocessing circuitry is configured to at least one of: save the volumeof medication dispensed to the one or more storage devices or sendinstructions to at least one of the one or more displays to output thevolume of medication dispensed on the at least one display.

In Example 13, the subject matter of Example 12 includes, wherein theinjection portal further comprises: an injection port that is configuredto fluidly couple to IV tubing; and at least one orienting memberconfigured to guide the received syringe having a diameter that is afirst diameter of a plurality of different diameters, to mate with theinjection port.

In Example 14, the subject matter of Examples 12-13 includes, wherein atleast one of the one or more medication sensors is an RFID interrogator,and wherein the medication identification information is an RFID tag.

In Example 15, the subject matter of Examples 12-14 includes, wherein atleast one of the one or more medication sensors is configured to readthe medication identification information and transmit a medicationidentity to the processing circuitry.

In Example 16, the subject matter of Examples 12-15 includes, whereinthe processing circuitry is configured to send instructions to at leastone of the one or more displays to output one or more of: a brand nameof a drug, a generic name of a drug, a drug concentration, a dosage of adrug, a dosage delivered, a fluid flow rate, a fluid volume delivered, apatient allergy, an over-dosing alert, a drug allergy alert and a druginteraction alert.

In Example 17, the subject matter of Examples 12-16 includes, whereinthe processing circuitry is configured to transmit dispensinginformation to one or more of: an electronic anesthetic record (EAR) andan electronic medical record (EMR), to automatically record dispensinginformation about the medication dispensed from the received syringe tothe EAR or the EMR.

In Example 18, the subject matter of Examples 12-17 includes, aninjection port located in the injection portal that is configured tofluidly couple the received syringe to IV tubing; and at least one clampin electrical communication with the processing circuitry, wherein theprocessing circuitry is configured send an instruction to actuate the atleast one clamp positioned one or more of upstream or downstream fromthe injection port, and wherein the processing circuitry is configuredto send instructions to the at least one clamp to inhibit dispensing ofthe medication or an IV fluid when an adverse condition is determined bythe processing circuitry.

Example 19 is a tamper-resistant, non-refillable syringe comprising: acylindrical syringe barrel extending from a first end having an openingconfigured to receive a movable plunger to a second end adjacent a Luertaper connector; a tamper-resistant hypodermic needle-blockingobstruction proximate the Luer taper connector to prevent receiving of ahypodermic needle through the Luer taper connector and into the syringebarrel; and a plunger seal coupled to the plunger, the plunger sealhaving one or more angled barbs that allow the plunger to be moved in adirection towards the Luer taper connector, and wherein the angled barbsinhibit movement of the plunger in a direction away from the Luer taperconnector to prevent refilling a syringe.

In Example 20, the subject matter of Example 19 includes, wherein acoupling interface between the plunger and the plunger seal isconfigured to disengage when the plunger is moved in a direction awayfrom the Luer taper connector.

In Example 21, the subject matter of Examples 19-20 includes, whereinthe plunger seal includes one or more spring wires molded into theplunger seal having barb tips formed by cut ends of the spring wiresprotruding outward from the plunger seal to poke into an inner surfaceof the syringe barrel.

In Example 22, the subject matter of Example 21 includes, wherein theone or more spring wires are angled toward the syringe barrel opening toallow movement of the plunger seal toward the Luer taper connector whileinhibiting movement of the plunger seal in an opposite direction by theone or more spring wires poking into an inner surface of the syringebarrel when the plunger is moved away from the Luer taper connector.

In Example 23, the subject matter of Examples 19-22 includes, whereinthe needle-blocking obstruction includes a polymer insert that is sizedto fit against an inside surface of the syringe barrel proximate theLuer taper connector, the needle-blocking obstruction further includinga solid central portion that directly opposes the opening to the Luertaper connector and one or more tortuous fluid channels that allow fluidflow in a longitudinal direction through the polymer insert and then ina transverse direction toward the opening to the Luer taper connector.

In Example 24, the subject matter of Example 23 includes, wherein theneedle-blocking obstruction includes a metal plate that is locatedopposite the opening to the Luer taper connector by the polymer insert,and wherein the metal plate is configured to block the insertion of ahypodermic needle through the Luer taper connector and into the syringebarrel.

In Example 25, the subject matter of Examples 23-24 includes, whereinthe polymer insert is sized to fit snuggly against the inside of thesyringe barrel proximate the Luer taper connector, and wherein thepolymer insert is bonded to the syringe barrel by one or more of a heatbond, ultrasonic bond, RF bond, adhesive bond or friction fit.

In Example 26, the subject matter of Examples 19-25 includes, whereinthe needle-blocking obstruction proximate the Luer taper connectorincludes a zig-zag fluid channel located between the first end of thesyringe barrel and a distal end of the Luer taper connector.

Example 27 is a system for delivering intravenous (IV) fluids from an IVbag fluidly that is coupled to a drip chamber and IV tubing, the systemcomprising: an IV scale configured to receive and support the IV bag;one or more sensors, wherein at least one of the one or more sensors isconfigured to identify an IV fluid in the IV bag hanging on the IV scaleand wherein at least one of the one or more sensors is located adjacentto the received drip chamber and is configured to capture an image ofthe drip chamber; one or more displays; one or more storage devices; andprocessing circuitry that is in electrical communication with the IVscale, the one or more sensors, the one or more displays and the one ormore storage devices, wherein the processing circuitry is configured toreceive a medication identity and a captured image of the drip chamberfrom the one or more sensors, and wherein the processing circuitry isconfigured to determine a fluid flow rate by analyzing an image of fluiddrops falling in the drip chamber including determining a size of dropsand a number of drops per unit time; wherein the processing circuitry isconfigured to at least one of: save the fluid flow rate to one or morestorage devices or send instructions to at least one of the one or moredisplays to output the fluid flow rate on at least one of the one ormore displays.

In Example 28, the subject matter of Example 27 includes, wherein the IVscale includes a hanger configured to support the IV bag, and whereinthe IV scale is configured to measure a combined weight of the IV bag,the IV drip chamber, the IV tubing and the fluids in the IV bag, andwherein the processing circuitry is configured to determine a reductionin a measured combined weight over time to determine a weight of thefluid removed from the IV bag and to convert the measured combinedweight over time to a fluid flow rate and an infused fluid volume.

In Example 29, the subject matter of Examples 27-28 includes, a floatlocated in the IV drip chamber, wherein when the processing circuitrydetermines from the captured image that the fluid drops in the dripchamber cannot be distinguished from one another and that the float ismoving, the processing circuitry is configured to measure the fluid flowrate by determining a reduction of a combined weight of the IV bag, theIV drip chamber, the IV tubing and fluid in the IV bag over time.

In Example 30, the subject matter of Examples 27-29 includes, one ormore electromechanical clamps that is in electrical communication withthe processing circuitry, wherein the processing circuitry is configuredto determine from the captured image that no fluid meniscus is presentin the drip chamber, the processing circuitry sends an instruction tocause at least one of the one or more electromechanical clamps tocompress the IV tubing to inhibit fluid flow prior to air entering theIV tubing.

Example 31 is at least one machine-readable medium includinginstructions that, when executed by processing circuitry, cause theprocessing circuitry to perform operations to implement of any ofExamples 1-30.

Example 32 is an apparatus comprising means to implement of any ofExamples 1-30.

Example 33 is a system to implement of any of Examples 1-30.

Example 34 is a method to implement of any of Examples 1-30.

What is claimed is:
 1. A module for acquiring and processing dose eventand response event digital data, the module comprising: one or moremachine vision digital cameras for acquiring dose event data; one ormore physiologic monitors for acquiring response event data; andprocessing circuitry and software in electrical communication with theone or more machine vision digital cameras and the one or morephysiologic monitors, the processing circuitry and software configuredto: automatically add timestamps to the dose event data and to theresponse event data; temporally correlate the dose event data withcorresponding response event data; identify, using artificialintelligence (AI) analytics of the processing circuitry and software, anexpected physiologic response or an unexpected physiologic response of apatient based on the temporally correlated dose event data and responseevent data; and provide alternative medication suggestions when theunexpected physiologic response is identified based on one or more of apatient's medical history, medication orders, vital signs, or currentmedications.
 2. The module of claim 1, wherein the processing circuitryand software include memories and databases configured to do one or moreof: receive physiological data, analyze physiological data, determinethat physiological data is unexpected, create and send instructions tocause an alert to a provider or another user, and save a physiologicalevent information to a storage device which may be a database.
 3. Themodule of claim 1, wherein at least a portion of the dose event data andthe response event data are displayed on one or more display screens. 4.The module of claim 1, wherein the dose event data and the responseevent data for the unexpected physiologic response are configured to bedisplayed on one or more remote display screens to be used for one ormore of remote supervision, remote consultation, remote monitoring orremote billing documentation.
 5. The module of claim 1, wherein theprocessing circuitry is configured to receive additional dose event dataand additional response event data from electronic medical equipment inelectrical communication with the processing circuitry of the module,wherein the additional dose event data and additional response eventdata relates to one or more of: physiologic monitors, fluid, gas andmedication administration, ventilator settings, pressure off-loading,blood loss, urine output, and anesthesia related events.
 6. A module foracquiring and processing dose event and response event digital data, themodule comprising: one or more machine vision digital camera foracquiring dose event data based on one or more dose event; one or morephysiologic monitor for acquiring response event data based on one ormore response event; and processing circuitry and software in electricalcommunication with the one or more machine vision digital camera and theone or more physiologic monitor, the processing circuitry and softwareconfigured to: automatically add timestamps to the dose event data andthe response event data allowing for temporal correlation of the one ormore dose event with the one or more response event; identify, usingartificial intelligence (AI) analysis, one or more expected physiologicresponse and one or more unexpected physiologic response to the one ormore dose event based on the dose event data and the response eventdata; and transmit a signal based on the one or more expectedphysiologic response and the one or more unexpected physiologic responseto provide automated (“self-driving” or “partially self-driving”)anesthesia during surgery or to provide automated medication delivery.7. The module of claim 6, wherein the processing circuitry and softwareinclude memory and one or more database in electrical communication withthe processing circuitry to: receive physiological data, analyzephysiological data, determine whether physiological data is unexpected,create and send instructions to cause an alert to a provider or anotheruser, and save a physiological event information to a storage device. 8.The module of claim 6, wherein data representing the one or more doseevent and the one or more response event are configured to be displayedon one or more display screen.
 9. The module of claim 6, wherein datarepresenting the one or more dose event and the one or more unexpectedphysiologic response are configured to be displayed on one or moreremote display screens to be used for one or more of: remotesupervision, remote consultation, remote monitoring, or remote billingdocumentation.
 10. The module of claim 6, wherein the processingcircuitry and software is configured to receive additional dose eventdata and additional response event data from electronic medicalequipment in electrical communication with the processing circuitry andsoftware, wherein the additional dose event data and the additionalresponse event data relates to one or more of: physiologic monitors;fluid, gas and medication administration; ventilator settings; pressureoff-loading; blood loss; urine output; and anesthesia related events.11. A system for acquiring and processing dose event and response eventdigital data, the system comprising: one or more machine vision digitalcameras for acquiring dose event data based on one or more does event;one or more physiologic monitors for acquiring response event data basedon one or more response event; and processing circuitry and software inelectrical communication with the one or more machine vision digitalcameras and the one or more physiologic monitors; wherein the processingcircuitry and software is configured to automatically add one or moretimestamps to the dose event data and the response event data; whereinthe processing circuitry and software is configured to temporallycorrelate the dose event data with the response event data based on theone or more timestamps; wherein the processing circuitry and softwareincludes artificial intelligence (AI) configured to identify one or moreexpected physiologic response and one or more unexpected physiologicresponse for the one or more dose event; wherein the processingcircuitry and software is configured to provide alternative medicationsuggestions when the one or more expected physiologic response and oneor more unexpected physiologic response is identified based on one ormore of a patient's medical history, medication orders, vital signs, andcurrent medications.
 12. The system of claim 11, wherein the processingcircuitry and software includes memory and one or more database incommunication with the processing circuitry and software and configuredto do one or more of: receive physiological data, analyze physiologicaldata, determine that physiological data is unexpected, create and sendinstructions to cause an alert to a provider or another user, and save aphysiological event information to a storage device.
 13. The system ofclaim 11, wherein data representing the one or more dose event and theone or more response event are configured to be displayed on one or moredisplay screens.
 14. The system of claim 11, wherein data representingthe one or more dose event and the one or more unexpected response eventare configured to be displayed on one or more remote display screens forone or more of remote supervision, remote consultation, remotemonitoring, and remote billing documentation.
 15. The system of claim11, wherein the processing circuitry is configured to receive additionaldose event and additional response event data from electronic medicalequipment in electrical communication with the processing circuitry andsoftware, wherein the additional dose event and additional responseevent data relates to one or more of: physiologic monitors, fluid, gasand medication administration, ventilator settings, pressureoff-loading, blood loss, urine output, anesthesia related events, andairway management.
 16. A system for acquiring and processing dose eventand response event digital data, the system comprising: one or moremachine vision digital cameras for acquiring dose event data based onone or more dose event; one or more physiologic monitors for acquiringresponse event data based on one or more response event; and processingcircuitry and software in electrical communication with the one or moremachine vision digital cameras and the one or more physiologic monitors;wherein the processing circuitry and software is configured toautomatically add one or more timestamps to the dose event data and tothe response event data wherein the processing circuitry and software isconfigured to temporally correlate the one or more dose event with theone or more response event based on the one or more timestamps of thedose event data and the response event data; wherein the processingcircuitry and software includes artificial intelligence (AI) configuredto identify expected physiologic responses and unexpected physiologicresponses to the one or more dose event; and wherein the artificialintelligence is configured to provide automated anesthesia duringsurgery or to provide automated medication delivery.
 17. The system ofclaim 16, wherein processing circuitry and software including memory anddatabases in electrical communication with the processing circuitry andsoftware to do one or more of: receive physiological data, analyzephysiological data, determine that physiological data is unexpected,create and send instructions to cause an alert to a provider or anotheruser, and save physiological event information to a storage device. 18.The system of claim 16, wherein the processing circuitry and softwareare configured to transmit the dose event data and the response eventdata for display on one or more display screens.
 19. The system of claim16, wherein the processing circuitry and software are configured totransmit the dose event data and the identified unexpected physiologicresponses for display on one or more remote display screens to be usedfor one or more of remote supervision, remote consultation, remotemonitoring, and remote billing documentation.
 20. The system of claim16, wherein the processing circuitry and software is configured toreceive additional dose event data and additional response event datafrom electronic medical equipment in electrical communication with theprocessing circuitry, wherein the additional dose event data and theadditional response event data relate to one or more of: physiologicmonitors; fluid, gas and medication administration; ventilator settings;pressure off-loading; blood loss; urine output; and anesthesia relatedevents.